| NPI | 1083884365 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN HAMPTON FULLERTON President/ Medical Director 415-202-9990 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: CA PA19632) |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care (Licence: CA PA19632) |
| Enumeration Date | 2008-03-03 |
| Last Update Date | 2008-04-16 |