Provider Demographics
NPI:1730145913
Name:CATHERINE G. FULLER, M.D. INC.
Entity Type:Organization
Organization Name:CATHERINE G. FULLER, M.D. INC.
Other - Org Name:COMPREHENSIVE ALLERGY AND ASTHMA ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-828-7978
Mailing Address - Street 1:11645 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 1150
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1708
Mailing Address - Country:US
Mailing Address - Phone:310-828-7978
Mailing Address - Fax:310-829-2306
Practice Address - Street 1:11645 WILSHIRE BLVD
Practice Address - Street 2:SUITE 1150
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1708
Practice Address - Country:US
Practice Address - Phone:310-828-7978
Practice Address - Fax:310-829-2306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43782207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19722Medicare PIN