Individual
DR. KEVIN L. FULFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5555 GROSSMONT CENTER DR, LA MESA, CA 91942-3019
(619) 704-4966
Mailing address
250 MURRAY DR, EL CAJON, CA 92020-4113
(423) 552-6924
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
A66474
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3861990
—
TN
Enumeration date
10/20/2006
Last updated
01/03/2020
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