Individual
LA'PORSCHA FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 SHADOW LANE, SUITE #106, LAS VEGAS, NV 89106
(702) 731-0909
(702) 826-4757
Mailing address
8936 SPANISH RIDGE AVE, CREDENTIALING, LAS VEGAS, NV 89148
(702) 998-2816
(702) 998-2991
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
11/20/2019
Last updated
11/20/2019
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