Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225XN1300X | Occupational Therapist - Neurorehabilitation | 12640 | CA |
Y | 225XP0200X | Occupational Therapist - Pediatrics | 4975 | AZ |
NPI | 1508134263 |
---|---|
Provider Name | Dr. Lucian Fulger |
First Address | Beverly Hills, CA 90212-3415 |
Second Address | Beverly Hills, CA 90212-3415 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2011 |
Last Update Date | 14/08/2014 |