Individual
IMANI S FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1480 PASEO VERDE PKWY APT 3211, HENDERSON, NV 89012-6510
(323) 793-3875
Mailing address
1480 PASEO VERDE PKWY APT 3211, HENDERSON, NV 89012-6510
(323) 793-3875
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/27/2022
Last updated
06/27/2022
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