Individual
JENNIFER CARROLL FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11234 ANDERSON ST # 2586A, LOMA LINDA, CA 92354-2804
(909) 558-7884
Mailing address
11234 ANDERSON ST # 2586A, LOMA LINDA, CA 92354-2804
(909) 558-7884
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
63479
MN
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
Primary
A160366
CA
Other
Enumeration date
03/27/2013
Last updated
07/10/2019
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