Individual
DR. HEATHER J. FULLERTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
505 PARNASSUS AVE, SAN FRANCISCO, CA 94143-2204
(415) 353-3681
Mailing address
1635 DIVISADERO ST STE 625 BOX 1821, SAN FRANCISCO, CA 94143-0001
(415) 476-4029
(415) 476-4150
Taxonomy
Speciality
Code
Description
License number
State
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
A67954
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A679540
—
CA
Enumeration date
01/12/2007
Last updated
07/09/2007
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