Individual
BENJAMIN A FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1300 LUISA ST STE 7, SANTA FE, NM 87505-4177
(505) 416-8009
Mailing address
1300 LUISA ST STE 7, SANTA FE, NM 87505-4177
(505) 416-8009
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/13/2023
Last updated
12/13/2023
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