Individual
EDWIN B FULLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 EUCLID AVE, SUITE 301, NATIONAL CITY, CA 91950-2957
(619) 267-3020
(619) 267-4042
Mailing address
655 EUCLID AVE, SUITE 301, NATIONAL CITY, CA 91950-2957
(619) 267-3020
(619) 267-4042
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
C26937
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C269370
—
CA
01
—
C26937
STATE LICENSE
CA
Enumeration date
07/29/2005
Last updated
08/25/2011
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