Individual
MS. MARTHA GRANT FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
3020 CHILDRENS WAY, SAN DIEGO, CA 92123-4223
(858) 576-1700
Mailing address
3020 CHILDRENS WAY # MC5148, SAN DIEGO, CA 92123-4223
(858) 966-8801
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
NP6272
CA
Other
Enumeration date
07/16/2007
Last updated
09/12/2022
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