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 18 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 |
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