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1285928523
JACQUELINE R. FULLER
POMONA, CA
NPI
1285928523
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2011-06-03
Last Update Date
2011-06-03
Business Address
-- JACQUELINE R. FULLER
160 E HOLT AVE
POMONA, CA 91767-5406
Phone number: 909-620-2521
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Mailing Address
-- JACQUELINE R. FULLER
313 S CATARACT AVE
SAN DIMAS, CA 91773-3015
Phone number: 909-933-0351
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