Elizabeth Wagner Fulp, PA

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA64929 Issued in CA

Practice address

3020 Childrens Way
San Diego, CA 92123-4223

Phone

(858) 966-8800

NPI assigned

Jul 11, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rady Children's Hospital San Diego

  dba Rady Children's Specialists of San Diego, A Medical Foundation

  • Pediatrics Physician
  • San Diego, CA
  • NPI 1669617197
  Medicare reassignment NPD
• Rady Children's Hospital San Diego

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • San Diego, CA
  • NPI 1851303994
  NPD
• Marilyn Kaufhold, M.D., a Medical Corporation

  • Children's Hospital
  • San Diego, CA
  • NPI 1336359389
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1548994171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY # MC5003",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-309-6300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3020 CHILDRENS WAY",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234223",
            "telephone_number": "858-966-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULP",
        "first_name": "ELIZABETH",
        "middle_name": "WAGNER",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-11",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "CA",
            "license": "PA64929",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Svetlana Gennadievna Fuller, RN
• William Mills Fuller, PA-C
• Nicole Fullerton
• Robert Armand Fullerton III, M.S.
• Tivona M Fullylove
• David Fulton Jr.
• Emily Jayne Fulton
• Jacob Fulton, SFIDC
• Juana Fulton, LCSW
• Priscilla Fultz

• Medical Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.