Provider Demographics
NPI:1093894594
Name:FULLER, LA CRYSTAL L (RNP, RNFA)
Entity Type:Individual
Prefix:MS
First Name:LA CRYSTAL
Middle Name:L
Last Name:FULLER
Suffix:
Gender:F
Credentials:RNP, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SUNNY CREST DR
Mailing Address - Street 2:SUITE 2800 MEDICAL CENTER FOR WOMEN
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3638
Mailing Address - Country:US
Mailing Address - Phone:714-992-5350
Mailing Address - Fax:714-992-8156
Practice Address - Street 1:1950 SUNNY CREST DR
Practice Address - Street 2:SUITE 2800 MEDICAL CENTER FOR WOMEN
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3638
Practice Address - Country:US
Practice Address - Phone:714-992-5350
Practice Address - Fax:714-992-8156
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14784363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA14784OtherLICENSE