Individual
DR. ELISA BROWN FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5880 SAN VICENTE BLVD STE 103, LOS ANGELES, CA 90019-6667
(310) 295-9571
Mailing address
10736 JEFFERSON BLVD # 412, CULVER CITY, CA 90230-4933
(310) 295-9528
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY32819
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7068
—
CA
05
—
7420
—
CA
Enumeration date
09/05/2012
Last updated
10/24/2025
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