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NPI Code Detail

MEDICARE: HALEE FULLERTON

MEDICARE: HALEE FULLERTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse Practitioner95015132CA
2363LP0808XPsychiatric/Mental Health Nurse PractitionerAPN.0994456-NPCO

General Provider Information

NPI Number : 1770049652
Entity Type Code : Individual
Provider Name (Legal Business Name) : HALEE FULLERTON
Provider Business Mailing Address
First Line : 215 S HICKORY ST STE 114
Second Line :
City : ESCONDIDO
State : CA
Zip : 92025-4360
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4633 OLD IRONSIDES DR STE 304
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-1846
Country : US
Telephone Number : 323-205-7088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2019
Last Update Date : 07/18/2025

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Directions to “ HALEE FULLERTON ” Practice Location

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