Provider Demographics
NPI:1578255030
Name:FULLER, ESSENCE UNIQUE
Entity Type:Individual
Prefix:
First Name:ESSENCE
Middle Name:UNIQUE
Last Name:FULLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1128 ADELINE ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2714
Mailing Address - Country:US
Mailing Address - Phone:209-326-7499
Mailing Address - Fax:
Practice Address - Street 1:1005 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1148
Practice Address - Country:US
Practice Address - Phone:510-899-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator