BERTRAM FULLER (NPI# 1073793691) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073793691 |
| Entity Type | Individual |
| Full Name | BERTRAM FULLER |
| Credential | PAC |
| Practice Address |
7033 Stewart and Gray Rd Unit 38 Downey CA 90241-4355 |
| Mailing Address |
Po Box 4808 Downey CA 90241-1808 |
| Practice Telephone | 5629270677 |
| Mailing Telephone | 5629270677 |
| Enumeration Date | 2007-11-12 |
| Last Update Date | 2007-11-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
PA 14719 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
7033 STEWART AND GRAY RD UNIT 38 |
| City | DOWNEY |
| State | CA |
| Zip Code | 90241-4355 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205036928 | Sylvia Surgical Assistant, Inc. | Physician Assistant | 7033 Stewart and Gray Rd Unit 38, Downey, CA 90241-4355 | 2007-07-20 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164029005 | Adam Lyle Barnhardt | Counselor | 11500 Paramont Blvd., Downey, CA 90241 | 2020-10-05 |
| 1922630482 | Betzabeth Benitez Perez | Counselor | Scadp, 11500 Paramount Blvd., Downey, CA 90241 | 2020-02-12 |
| 1457858714 | Diane Padre-gozun | Student in an Organized Health Care Education/Training Program | 11500 Brookshire Ave, Gme Office, Downey, CA 90241 | 2018-04-12 |
| 1295233963 | Community Family Guidance Center | Community/Behavioral Health | 12330 Woodruff Ave, Downey, CA 90241 | 2018-01-29 |
| 1487167433 | Progressive Medical Associates | Health Maintenance Organization | 6611 Seville Avenue, Huntington Park, CA 90241 | 2017-11-13 |
| 1194236018 | Dental Office of Downey Inc. | Clinic/Center | 10917 Paramounth Blvd, Downey, CA 90241 | 2017-10-18 |
| 1376063933 | Sophea Tim | Pharmacist | 11525 Brookshire Avenue Suite 400, Downey, CA 90241 | 2017-06-26 |
| 1952835282 | Dr. Jose Flores D.d.s Inc. | Preferred Provider Organization | 11510 Downey Ave, Downey, CA 90241 | 2017-04-13 |
| 1053844043 | Stephen Nealon Berberich | Internal Medicine | 1544 Downey Ave, Downey, CA 90241 | 2017-04-06 |
| 1225424187 | Davis Huang | Internal Medicine | 11500 Brookshire Ave., Downey, CA 90241 | 2015-04-07 |
| Find all providers in zip 90241 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205036928 | Sylvia Surgical Assistant, Inc. | Physician Assistant | 7033 Stewart and Gray Rd Unit 38, Downey, CA 90241-4355 | 2007-07-20 |
| 1962850313 | Brian Kim | Physician Assistant | 9353 Imperial Hwy, Downey, CA 90242-2812 | 2016-05-26 |
| 1225465230 | Samuel J Lagunas | Physician Assistant | 9353 Imperial Hwy, Downey, CA 90242-2812 | 2013-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649894403 | Kathlyn Larco | Physician Assistant | 1233 W Randall Way, West Covina, CA 91790-4747 | 2020-06-07 |
| 1487126421 | Eliza Hughes | Physician Assistant | 860 Oak Park Blvd Ste 101, Arroyo Grande, CA 93420-1800 | 2018-12-31 |
| 1508333873 | Andrew Cantos Malit | Physician Assistant | 409 Bristol Way, Corona, CA 92879-6156 | 2018-10-25 |
| 1578049458 | Ida Jelveh | Physician Assistant | 28096 Edelweiss Ct, Laguna Niguel, CA 92677-7006 | 2018-07-13 |
| 1356833578 | Michael James Gonzalez | Physician Assistant | 1500 E Chevy Chase Dr # 401a401b, Glendale, CA 91206-4152 | 2018-06-04 |
| 1023500592 | Pamela Lambert Pa-c, Inc. | Physician Assistant | 16105 Mariposa Ave, Riverside, CA 92504-8730 | 2018-05-31 |
| 1225532385 | Folsom Physicain Assistant First Assist, Inc | Physician Assistant | Nina Vasiliev Pa-c, 15407 Muller Rd, Plymouth, CA 95669-9770 | 2018-03-22 |
| 1275040008 | Gm Surgical Assistant Inc | Physician Assistant | 15615 Turnberry St, Moreno Valley, CA 92555-4901 | 2018-01-02 |
| 1902311186 | Or Solutions Inc | Physician Assistant | 1501 Secret Ravine Pkwy Unit 527, Roseville, CA 95661-6005 | 2017-12-09 |
| 1184143828 | Alaa Abdalla Daghlas | Physician Assistant | 1100 S Eliseo Dr Ste A, Greenbrae, CA 94904-2017 | 2017-09-13 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.