Individual provider · Type 1 NPI
Michael Charles Fuller Jr.
Rehabilitation Practitioner · Beaumont, CA
NPI number
1083084115
Active
Practice location
14763 Manzanita Rd
Beaumont, CA 92223-3026
Mailing address
1076 Santo Antonio Dr
Colton, CA 92324-8103
Other practice locations
- 1076 Santo Antonio Dr, Colton, CA 92324-8103 · (909) 433-9824
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Rehabilitation Practitioner Primary | 225400000X | 17771 (CA) |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 17771 (CA) |
Rehabilitation Practitioner: A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.
Other rehabilitation practitioner providers in Beaumont
About NPI 1083084115
Michael Charles Fuller Jr.'s National Provider Identifier is 1083084115, issued on Oct 1, 2015. The primary taxonomy on file is Rehabilitation Practitioner (225400000X), and the practice location is in Beaumont, CA. The record was last updated on Aug 21, 2025.