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Organization

FULLER PSYCHOLOGY CORPORATION

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. RUSSELL F FULLER PSY.D. (PRESIDENT, CLINICAL PSYCHOLOGIST)
(858) 558-7707
Entity
Organization

Contact information

Practice address
4225 EXECUTIVE SQ, SUITE 1110, LA JOLLA, CA 92037-9122
(858) 558-7707
(858) 558-7708
Mailing address
4225 EXECUTIVE SQ, SUITE 1110, LA JOLLA, CA 92037-9122
(858) 558-7707
(858) 558-7708

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY16530
CA

Other

Enumeration date
05/03/2008
Last updated
05/03/2008
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