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Organization
SIGNATURE MINDCARE MEDICAL CORPORATION
Active
Organization
SIGNATURE MINDCARE MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LA CRYSTAL FULLER (OWNER)
(315) 547-0502
Entity
Organization
Contact information
Practice address
2283 WALTONIA DR, MONTROSE, CA 91020-1261
(323) 849-3309
Mailing address
2283 WALTONIA DR, MONTROSE, CA 91020-1261
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
NULL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
07/28/2026
Last updated
07/28/2026
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