Russell F Fuller I, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY16530 Issued in CA

Practice address

4225 Executive SQ
Suite 1110
La Jolla, CA 92037-9122

Phone

(858) 558-7707

Fax

(858) 558-7708

NPI assigned

Nov 5, 2013

Sex

Male

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

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.

• Fuller Psychology Corporation

  • Clinical Psychologist
  • La Jolla, CA
  • NPI 1437325040
  NPD (past) Authorized official

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

{
    "created_epoch": "1383609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1912336413",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4225 EXECUTIVE SQ",
            "address_2": "SUITE 1110",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379122",
            "telephone_number": "858-558-7707",
            "fax_number": "858-558-7708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4225 EXECUTIVE SQ",
            "address_2": "SUITE 1110",
            "city": "LA JOLLA",
            "state": "CA",
            "postal_code": "920379122",
            "telephone_number": "858-558-7707",
            "fax_number": "858-558-7708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FULLER",
        "first_name": "RUSSELL",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "name_suffix": "I",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-11-05",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY16530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jamie Fugett, DPT
• Casey Carol Retiro Fulinara, PA
• Lauren Fulkerson, M.D.
• Fuller Psychology Corporation
• Ashley Fuller, RN
• William D. Fuller, M.D.
• Amy Funari, CRNP
• Linli Fung
• Jessica Lynne Funk, FNP-BC
• Timothy James Furnish, M.D.

• Clinical Psychologist in La Jolla, CA
• Providers in La Jolla, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; 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.