Provider Demographics
NPI:1689687386
Name:FULAN, JOHN (LMFT, M-RAS)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FULAN
Suffix:
Gender:M
Credentials:LMFT, M-RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 19085
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92159-0085
Mailing Address - Country:US
Mailing Address - Phone:619-218-1129
Mailing Address - Fax:619-265-1873
Practice Address - Street 1:2727 CAMINO DEL RIO SOUTH
Practice Address - Street 2:311
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1665
Practice Address - Country:US
Practice Address - Phone:619-218-1129
Practice Address - Fax:619-265-1873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist