MICHAEL CHARLES FULLER NPI 1083084115

NPI Information

  • NPI: 1083084115
  • Provider Name: MICHAEL CHARLES FULLER
  • Classification: Rehabilitation Practitioner - 225400000X
  • Entity Type: Individual
  • Address: 14763 MANZANITA RD
    BEAUMONT, CA
    ZIP 92223
  • Phone: (909) 433-9824

Map and Directions

Get Directions

NPI Details

Michael Charles Fuller is a rehabilitation practitioner in Beaumont, CA. The provider is a health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity. Michael Charles Fuller NPI is 1083084115. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

14763 MANZANITA RD
BEAUMONT, CA
ZIP 92223-026
Phone: (909) 433-9824

The enumeration date for this NPI number is 10/1/2015 and was last updated on 8/21/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1225400000XRehabilitation Practitioner17771CALIFORNIAYes
2101YA0400XCounselorAddiction (Substance Use Disorder)17771CALIFORNIANo

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.