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NPI Code Detail

MEDICARE: JOHN RICHARD FAULL PH.D.

MEDICARE: JOHN RICHARD FAULL PH.D.
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
1103T00000XPsychologistPSY6170CA

General Provider Information

NPI Number : 1942303920
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN RICHARD FAULL PH.D.
Provider Business Mailing Address
First Line : 1600 9TH ST
Second Line : ROOM 205 MAILSTOP 2-3
City : SACRAMENTO
State : CA
Zip : 95814-6404
Country : US
Telephone Number : 916-654-2431
Fax Number : 916-654-3186
Provider Business Practice Location Address
First Line : 3500 ZANKER RD
Second Line :
City : SAN JOSE
State : CA
Zip : 95134-2201
Country : US
Telephone Number : 408-451-6198
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2006
Last Update Date : 07/08/2007

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