Robert Fuller

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

AII053220318 Issued in CA

Practice address

239 W 9TH St
Upland, CA 91786-5979

Phone

(909) 981-6121

NPI assigned

Apr 4, 2007

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• G & C Swan Inc

  dba His House

  • Substance Abuse Rehabilitation Facility
  • Upland, CA
  • NPI 1659662351
  NPD
• His House New Creation Treatment Center

  • Addiction (Substance Use Disorder) Counselor
  • Upland, CA
  • NPI 1376371187
  NPD
• WCHS Inc

  dba Riverside Treatment Center

  • Methadone Clinic
  • Riverside, CA
  • NPI 1194735829
  NPD (past)
• WCHS, Inc

  dba Bellingham Treatment Solutions

  • Methadone Clinic
  • Bellingham, WA
  • NPI 1811592116
  NPD (past)

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698278400000",
    "number": "1609998459",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2948 GENEVIEVE ST",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924053520",
            "telephone_number": "909-977-9702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "239 W 9TH ST",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917865979",
            "telephone_number": "909-981-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "ROBERT",
        "name_prefix": "Mr.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2023-10-26",
        "certification_date": "2023-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CA",
            "license": "AII053220318",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald Stanley Friedman, MD
• Kellie Bree Fritchel, M.S. LMFT
• Patricia B. Fromer, M.S.
• Lisa Faye Fronek, DO
• Fuel Shop LLC
• Fun Lac Inc (Upland Acupuncture & Wellness)
• Kimberly Wen Fung, FNP-BC
• Rhea Alysia Fyffe, MSN, PMHNP-BC
• G & C Swan Inc (His House)
• G & C Swan Inc (His House)

• Addiction (Substance Use Disorder) Counselor in Upland, CA
• Providers in Upland, CA by specialty
• Addiction (Substance Use Disorder) Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.