Active NPI
Camille Evon Fuller, DPT
- Physical Therapist
- Lake Arrowhead, CA
National Provider Identifier
1962047688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 297745
- Practice address
- 29101 Hospital Rd
Lake Arrowhead, CA 92352-9706 - Phone
- (909) 336-3651
- NPI assigned
- Nov 18, 2019
- Last updated
- Nov 18, 2019
- 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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 297745 | CA | Primary |
Addresses
Primary practice location
29101 Hospital Rd
Lake Arrowhead, CA 92352-9706
Mailing address
PO Box 1703
Crestline, CA 92325-1703
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 297745 | CA | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574035200000",
"number": "1962047688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1703",
"city": "CRESTLINE",
"state": "CA",
"postal_code": "923251703"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "29101 HOSPITAL RD",
"city": "LAKE ARROWHEAD",
"state": "CA",
"postal_code": "923529706",
"telephone_number": "909-336-3651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FULLER",
"first_name": "CAMILLE",
"middle_name": "EVON",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-11-18",
"last_updated": "2019-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "297745",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Arrowhead, CA
- Virginia (Ginny) Dern Dunn, DPT
- Elite Hospitalist Medical Group, Inc.
- Marguerita Reyes Eno, CCC-SLP
- Laurie Kathleen Everett, P.T.
- Gloria Esther Fontes, LCSW
- Mary Edith Galvin, RNC FNP PHD
- Garfield Beach CVS LLC (CVS Pharmacy # 10999)
- Guy Gerald Giacopuzzi, DDS
- John Clarke Hankey, MD
- Jay Allen Hartstein, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 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.