| Doctor Name: | MR. PAUL R FULLER |
| NPI Number: | 1144326786 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | CATC-III 960047 |
| Business Practice Address: | 5 Mareblu Ste 259 Aliso Viejo, CA - 926563014 |
| Business Phone Number: | 9496436930 |
| Business Fax Number: | |
| Mailing Address: | 5 Mareblu, Suite 259 ALISO VIEJO |
| State: | CA |
| Postal Code: | 926563014 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 09/14/2006 |
| NPI Last Update Date: | 06/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | CATC-III 960047 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |