Active NPI
Benjamin Fuller, ATC
- Athletic Trainer
- Azusa, CA
National Provider Identifier
1407400799
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 701 E Foothill Blvd
Azusa, CA 91702-2606 - Phone
- (626) 815-6000
- Fax
- (626) 815-5442
- NPI assigned
- Jul 25, 2019
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | Primary |
Addresses
Primary practice location
701 E Foothill Blvd
Azusa, CA 91702-2606
Mailing address
PO Box 7000
Azusa, CA 91702-7000
Phone (626) 815-6000
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1564012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1564012800000",
"number": "1407400799",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7000",
"city": "AZUSA",
"state": "CA",
"postal_code": "917027000",
"telephone_number": "626-815-6000",
"fax_number": "626-815-5442"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E FOOTHILL BLVD",
"city": "AZUSA",
"state": "CA",
"postal_code": "917022606",
"telephone_number": "626-815-6000",
"fax_number": "626-815-5442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "BENJAMIN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-07-25",
"last_updated": "2019-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Azusa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.