Fuller, Jack G.
Fuller, Jack G. is an individual health care provider with primary practice located at 1225 Wilshire Boulevard , Los Angeles CA 90017-2395. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Fuller, Jack G. can be contacted via phone (213) 977-2423.Contact Information
Primary practice address
1225 Wilshire Boulevard
Los Angeles CA 90017-2395
Phone: (213) 977-2423
Fax: (213) 202-7028
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA12536 | California |
Profile Details
| NPI number | 1376596668 |
|---|---|
| LBN Legal business name | Fuller, Jack G. |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 18th, 2006 |
| Last updated | Jul 9th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376596668 | NPPES |
| California | Other | P00198638 | GOOD SAMARITAN RAILROAD |
| California | MEDICAID | PA12536 | GOOD SAMARITAN RAILROAD |
Popular Providers
-
Balkis, Jovana
9601 S Sepulveda Blvd , Los Angeles CA 90045-5203 -
Pham, Johnny-An Thanh
1101 N Vermont Ave , Los Angeles CA 90029 -
Park, Daniel
1441 Eastlake Ave Ste 7416, Los Angeles CA 90089-2211 -
Ryndin, Natalia
1401 S Grand Ave Emergency Department, Los Angeles CA 90015-3010 -
Raphael, Carmel Nichole
4314 W Slauson Ave , Los Angeles CA 90043-2808 -
Tristan, Vincent Manuel
1510 San Pablo St 2Nd Floor, Los Angeles CA 90033-5320 -
Frize, Rosina Burnis
5059 York Blvd , Los Angeles CA 90042-1713 -
Duong, Mary Chung-Ning
12414 Exposition Blvd , Los Angeles CA 90064-1016