Provider Demographics
NPI:1659399244
Name:FULARA, INDIRA B (MD)
Entity Type:Individual
Prefix:
First Name:INDIRA
Middle Name:B
Last Name:FULARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 N 1ST ST
Mailing Address - Street 2:#505
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95113-1202
Mailing Address - Country:US
Mailing Address - Phone:408-280-7255
Mailing Address - Fax:
Practice Address - Street 1:25 N 1ST ST
Practice Address - Street 2:#505
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95113-1202
Practice Address - Country:US
Practice Address - Phone:408-280-7255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA80715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI49228Medicare UPIN