Individual
MICHAEL CHARLES GONZALEZ FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5225 23RD AVE S, FARGO, ND 58104-7927
(406) 202-5134
Mailing address
5225 23RD AVE S, FARGO, ND 58104-7927
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/31/2025
Last updated
04/13/2025
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