Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 21327 | CA |
N | 111NN1001X | Nutrition | 21327 | CA |
NPI | 1013232883 |
---|---|
Provider Name | Dr. Ingrid Nora Fullerton |
First Address | San Marcos, CA 92069 |
Second Address | San Marcos, CA 92078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2010 |
Last Update Date | 15/04/2010 |