Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 20A9099 | CA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 20A9099 | CA |
NPI | 1285624650 |
---|---|
Provider Name | Christian J. Fulmer |
First Address | San Jose, CA 95126-3518 |
Second Address | Campbell, CA 95008-0259 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/10/2005 |
Last Update Date | 05/08/2014 |