JERRY WALLACE FULFORD (NPI# 1427547355) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427547355 |
| Entity Type | Individual |
| Full Name | JERRY WALLACE FULFORD |
| Practice Address |
4170 Gross Rd. Extension Suite 6 Capitola CA 95010 |
| Practice Telephone | 8314641605 |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2018-05-07 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 225700000X | Massage Therapist | 75622 | CA | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
4170 GROSS RD. EXTENSION SUITE 6 |
| City | CAPITOLA |
| State | CA |
| Zip Code | 95010 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609436641 | Suzanne Lerner | Psychologist | 720a Capitola Ave, Capitola, CA 95010 | 2019-06-20 |
| 1801351317 | Michael Stephen Quinn | Chiropractor | 720 A- Capitola Ave, Capitola, CA 95010 | 2019-02-08 |
| 1053885194 | Health In Mind P.C. | Psychiatry & Neurology | 610 Capitola Ave, Capitola, CA 95010 | 2019-01-11 |
| 1457730293 | Cpap Experts LLC | Durable Medical Equipment & Medical Supplies | 820 Bay Ave #203a, Capitola, CA 95010 | 2015-05-26 |
| 1972904241 | Molly Chaudoir | Acupuncturist | 4170 Gross Rd. Ext., Suite 6, Santa Cruz, CA 95010 | 2014-09-05 |
| 1245598374 | Stan C Wolken | Dentist | 4770 Capitola Rd, Capitola, CA 95010 | 2012-04-26 |
| 1104103399 | Jacinda Ann Maurer | Registered Nurse | 4725 Grace Street, Apt. 1, Capitola, CA 95010 | 2011-11-16 |
| 1508043225 | Brian J. Schabel, Dds, Ms & Vivian H. Chan, Dds, Ms, Inc. | Dentist | 1830 41st Ave., Capitola, CA 95010 | 2008-01-24 |
| 1609066679 | Sandra Polakoff | Marriage & Family Therapist | 519 Capitola Avenue, Suite B, Capitola, CA 95010 | 2007-07-26 |
| 1043423825 | Michael Andrew Koplen | Chiropractor | 4895 Capitola Road, Capitola, CA 95010 | 2007-05-08 |
| Find all providers in zip 95010 | ||||
| Taxonomy Code | 225700000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Massage Therapist |
| An individual trained in the manipulation of tissues (as by rubbing, stroking, kneading, or tapping) with the hand or an instrument for remedial or hygienic purposes. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760967491 | David William Fournier | Massage Therapist | 4895 Capitola Rd, Capitola, CA 95010-3810 | 2018-09-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578164265 | Gary L Johnson | Massage Therapist | 222 Columbus Ave Ste 220, San Francisco, CA 94133-4597 | 2020-11-08 |
| 1720689508 | Cebrina Dieli | Massage Therapist | 470 Forest Park Blvd., C-212, Oxnard, CA 93036 | 2020-11-06 |
| 1528669348 | Matthew P Martinez | Massage Therapist | 417 N Citrus Ave Apt 7, Escondido, CA 92027-2765 | 2020-11-06 |
| 1841891603 | Jenni Asher | Massage Therapist | 5425 1/2 Vantage Avenue, Valley Village, CA 91607 | 2020-11-06 |
| 1316548456 | Paulo Conceicao | Massage Therapist | 6559 Comly St, San Diego, CA 92111-5401 | 2020-11-05 |
| 1023619079 | Reanna Whitnall | Massage Therapist | 9950 Campo Rd Ste 204, Spring Valley, CA 91977-1629 | 2020-11-05 |
| 1073114252 | Briana Hill | Massage Therapist | 2203 San Remo Cir, Vista, CA 92084-7727 | 2020-11-04 |
| 1770184954 | Michelle Ann Moeller | Massage Therapist | 5648 Oak Grove Ave, Oakland, CA 94618-1243 | 2020-11-04 |
| 1013518315 | Mayulee Wilawanwelsh | Massage Therapist | 349 S Lafayette Pk Pl, Los Angeles, CA 90057 | 2020-11-03 |
| 1194326553 | Suzanne Romero | Massage Therapist | 411 Alvarado St Apt 201, Monterey, CA 93940-2710 | 2020-11-03 |
| Find all providers with the same taxonomy | ||||
Please comment or provide details below to improve the information on JERRY WALLACE FULFORD.
| 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.