Individual
IVONNE DE CARLO FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S
Contact information
Practice address
1011 BALDWIN PARK BLVD, BALDWIN PARK, CA 91706-5806
(626) 851-6671
Mailing address
14008 ROCKENBACH ST, BALDWIN PARK, CA 91706-2463
(818) 601-7644
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
20326
CA
Other
Enumeration date
10/21/2011
Last updated
12/16/2021
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