BENJAMIN FULLER (NPI# 1407400799) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1407400799 |
| Entity Type | Individual |
| Full Name | BENJAMIN FULLER |
| Credential | ATC |
| Practice Address |
701 E Foothill Blvd Azusa CA 91702-2606 |
| Mailing Address |
Po Box 7000 Azusa CA 91702-7000 |
| Practice Telephone | 6268156000 |
| Practice Fax Number | 6268155442 |
| Mailing Telephone | 6268156000 |
| Mailing Fax Number | 6268155442 |
| Enumeration Date | 2019-07-25 |
| Last Update Date | 2019-07-25 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689802910 | Benjamin Luke Fuller | Dentist | 835 3rd Ave Sw, Cedar Rapids, IA 52404-1810 | 2009-06-25 |
| 1841710902 | Benjamin Fuller | Anesthesiology | 1 Barnes Jewish Hospital Plz, Saint Louis, MO 63110-1003 | 2017-06-20 |
| Street Address |
701 E FOOTHILL BLVD |
| City | AZUSA |
| State | CA |
| Zip Code | 91702-2606 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861475550 | Michael Stephen Laymon | Physical Therapist | 701 E Foothill Blvd, Mary Hill 104, Azusa, CA 91702-2606 | 2005-11-28 |
| 1881249647 | Garrett Rand Brooks | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2019-08-07 |
| 1285289611 | Bryce Jay Allen Gordon | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2019-08-02 |
| 1679067052 | Jorden Rae Hart | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2018-06-19 |
| 1346745023 | Christy Hancock | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2018-03-26 |
| 1316440605 | Carlos Benedict Gonzalez | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2018-03-13 |
| 1720581010 | Daja Kinney | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2018-03-13 |
| 1639606338 | Shirley Gettings | Registered Nurse | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2017-05-12 |
| 1346664356 | Catherine Wilde Mcphee | Rehabilitation Hospital | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2014-02-11 |
| 1336434950 | Irina Thomas | Nurse Practitioner | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2011-06-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407345341 | Rosaura Contreras | Nutritionist | 109 West 6th Street, Azusa, CA 91702 | 2018-05-07 |
| 1093224396 | Beatriz Leyva Torres | Nurse Practitioner | 237 S. Vernon Ave, Azusa, CA 91702 | 2017-09-29 |
| 1871949370 | Angela Marie Mckindley | Case Manager/Care Coordinator | 23701 East Fork Rd., Azusa, CA 91702 | 2016-05-13 |
| 1023489846 | Crystal Horton | Case Manager/Care Coordinator | 23701 E Fork Road, Azusa, CA 91702 | 2015-10-20 |
| 1528438272 | Seann Mckay | Case Manager/Care Coordinator | 23701 E Folk Rd, Azusa, CA 91702 | 2015-10-06 |
| 1437528833 | William Clabaugh | Case Manager/Care Coordinator | 830 S. Azusa Ave., 45, Azusa, CA 91702 | 2015-09-16 |
| 1467850693 | Juana Gaeta | Speech-Language Pathologist | 1016 E Ghent St, Azusa, CA 91702 | 2014-12-22 |
| 1649674508 | Colleen Anne Montz | Nurse Practitioner | 901 E. Alosta Ave., Student Health Center, Azusa, CA 91702 | 2014-10-21 |
| 1285061390 | Patrick Ryan Bergeron | Physical Therapist | 900 W Sierra Madre Avenue, #33, Azusa, CA 91702 | 2013-10-03 |
| 1760768972 | Ashley L Wickliffe | Student in an Organized Health Care Education/Training Program | 901 East Alosta Avenue, Azusa, CA 91702 | 2011-11-01 |
| Find all providers in zip 91702 | ||||
| Taxonomy Code | 2255A2300X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Specialist/Technologist |
| Specialization | Athletic Trainer |
| Athletic trainers are allied health care professionals who work in consultation with or under the direction of physicians, and specialize in the prevention, assessment, treatment and rehabilitation of injuries and illnesses. Currently, the entry-level employment requirements are a bachelor’s degree with a major in athletic training from an accredited university or college. A majority of athletic trainers hold advanced degrees. National board certification is generally required as a condition of state licensure and employment. Most states regulate athletic trainers, and they practice within the scope of that license or regulation. Clinical practice includes emergency care, rehabilitation, reconditioning, therapeutic exercise, wellness programs, exercise physiology, kinesiology, biomechanics, nutrition, psychology and health care administration. |
| Notes: Source: National Athletic Trainers’ Association (www.NATA.org) [1/1/2006: modified definition, modified source] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033603576 | Morgan Moore | Specialist/Technologist | 156 S Jackson Ave, Azusa, CA 91702-4254 | 2018-06-19 |
| 1467981035 | Samuel Newsome | Specialist/Technologist | 308 N Azusa Ave, Azusa, CA 91702-3439 | 2017-06-07 |
| 1679592240 | April M Reed | Specialist/Technologist | 701 East Foothill Boulevard, Azusa, CA 91702-7000 | 2006-07-18 |
| 1669096590 | Meagan Rachelle Mansfield | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-06-06 |
| 1245854181 | Sydnie Lovegreen | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-06-06 |
| 1386268225 | Sara Yvelesse Thompson | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-06-06 |
| 1114541554 | Keiloni Marie Smith | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-06-02 |
| 1073136107 | Kayla Ozawa | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-05-22 |
| 1982225678 | Taylor Lyle Magallanes | Specialist/Technologist | 901 E Alosta Ave, Azusa, CA 91702-2701 | 2020-05-04 |
| 1881249647 | Garrett Rand Brooks | Specialist/Technologist | 701 E Foothill Blvd, Azusa, CA 91702-2606 | 2019-08-07 |
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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.