Individual
GREGORY FULLANTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8413 PALAIS RD, STANTON, CA 90680-1718
(714) 651-9560
Mailing address
8413 PALAIS RD, STANTON, CA 90680-1718
(714) 651-9560
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
37338
CA
Other
Enumeration date
02/11/2016
Last updated
02/11/2016
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