Provider Demographics
NPI:1386910388
Name:FULLER, TOVA (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:TOVA
Middle Name:
Last Name:FULLER
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 DUDLEY AVE APT 309
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2302
Mailing Address - Country:US
Mailing Address - Phone:310-433-3850
Mailing Address - Fax:
Practice Address - Street 1:101 DUDLEY AVE APT 309
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2302
Practice Address - Country:US
Practice Address - Phone:310-433-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-24
Last Update Date:2012-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program