Individual
BRIAN K FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3211 JEFFERSON ST, SAN DIEGO, CA 92110-4424
(619) 682-4012
Mailing address
2051 LILAC LN, ALPINE, CA 91901-2932
(248) 762-1014
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
09/28/2009
Last updated
09/28/2009
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