Individual
BENJAMIN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
701 E FOOTHILL BLVD, AZUSA, CA 91702-2606
(626) 815-6000
(626) 815-5442
Mailing address
PO BOX 7000, AZUSA, CA 91702-7000
(626) 815-6000
(626) 815-5442
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
Other
Enumeration date
07/25/2019
Last updated
07/25/2019
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