Active NPI
Michele Fullmer, MD
- Specialist
- Irvine, CA
National Provider Identifier
1245219575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- G47690
- Practice address
- 16300 Sand Canyon Ave
Suite 612
Irvine, CA 92618-3711 - Phone
- (949) 753-1001
- Fax
- (949) 753-1115
- NPI assigned
- Jan 13, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | G47690 | CA | Primary |
Addresses
Primary practice location
16300 Sand Canyon Ave
Suite 612
Irvine, CA 92618-3711
Mailing address
16300 Sand Canyon Ave., #612
Irvine, CA 92618
Phone (949) 753-1001
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G47690 | CA | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137110400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1229472000000",
"number": "1245219575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "16300 SAND CANYON AVE., #612",
"city": "IRVINE",
"state": "CA",
"postal_code": "92618",
"telephone_number": "949-753-1001",
"fax_number": "949-753-1115"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16300 SAND CANYON AVE",
"address_2": "SUITE 612",
"city": "IRVINE",
"state": "CA",
"postal_code": "926183711",
"telephone_number": "949-753-1001",
"fax_number": "949-753-1115"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLMER",
"first_name": "MICHELE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-01-13",
"last_updated": "2008-12-17",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "CA",
"license": "G47690",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irvine, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.