Individual
KENYA MONIQUE FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7224 S RECOVERY RD, FRENCH CAMP, CA 95231-8901
(209) 888-6595
Mailing address
7224 S RECOVERY RD, FRENCH CAMP, CA 95231-8901
(209) 888-6596
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40338
CA
Other
Enumeration date
06/24/2024
Last updated
10/21/2024
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