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NPI Code Detail

MEDICARE: KIM E FULLER

MEDICARE: KIM E FULLER
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
1106H00000XMarriage & Family TherapistMFC38537CA

General Provider Information

NPI Number : 1831221118
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIM E FULLER
Provider Business Mailing Address
First Line : PO BOX 7402
Second Line :
City : LONG BEACH
State : CA
Zip : 90807-0402
Country : US
Telephone Number : 323-336-2294
Fax Number :
Provider Business Practice Location Address
First Line : 1501 HUGHES WAY
Second Line : STE 150
City : LONG BEACH
State : CA
Zip : 90810-1876
Country : US
Telephone Number : 310-221-6336
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/12/2007
Last Update Date : 06/30/2015

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Directions to “ KIM E FULLER ” Practice Location

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