MICHAEL CHARLES FULLER JR.
NPI 1083084115
Rehabilitation Practitioner in Beaumont, CA

Q: What is Michael Fuller's NPI number?

The NPI number for Michael Fuller is 1083084115. It was assigned to this individual provider in the NPPES registry on October 1, 2015.

Q: What is Michael Fuller's specialty?

The primary specialty registered for this NPI is Rehabilitation Practitioner with taxonomy code 225400000X.

Q: When was this NPI record last updated?

The NPPES record for Michael Fuller was last updated on August 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since October 01, 2015

14763 MANZANITA RD, BEAUMONT, CA 92223(909) 433-9824 Get Directions Write a Review

NPPES record last updated: August 21, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Jul 2, 2024, Jun 27, 2024, Oct 1, 2015 (3 updates tracked since 2015).

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About Michael Charles Fuller Jr. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHAEL CHARLES FULLER JR. (NPI 1083084115) is an individual rehabilitation practitioner in Beaumont, California, licensed in California (17771) and active in the NPI registry since October 2015. He maintains a secondary practice location in Colton.

NPPES Registry Identity

NPI1083084115

Entity TypeIndividualMale

Primary Taxonomy225400000X

Provider Legal NameMICHAEL CHARLES FULLER JR.

Location Address14763 MANZANITA RDBeaumont, CA 92223-3026

Mailing Address1076 Santo Antonio DrColton, CA 92324-8103 · (909) 433-9824

Phone(909) 433-9824

Sole ProprietorYes

Enumeration DateOctober 1, 2015

Last NPPES UpdateAugust 21, 20253 updates tracked since enumeration

NPPES CertifiedAugust 21, 2025

✔ NPI 1083084115 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyRehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers

Taxonomy Code225400000X

License✔ Licensed in CA · 17771

Definition

A health care practitioner who trains or retrains individuals disabled by disease or injury to help them attain their maximum functional capacity.

Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X · License 17771 (CA)

14763 MANZANITA RD, Beaumont, CA 92223

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Secondary Practice Location 1

Location 11076 Santo Antonio DrColton, CA 92324-8103 · Phone (909) 433-9824

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Michael Fuller's NPI number?

The NPI number for Michael Fuller is 1083084115. It was assigned to this individual provider in the NPPES registry on October 1, 2015.

Where is Michael Fuller located?

Michael Fuller practices at 14763 Manzanita Rd, Beaumont, CA 92223. The listed phone number is (909) 433-9824.

What is Michael Fuller's specialty?

The primary specialty registered for this NPI is Rehabilitation Practitioner with taxonomy code 225400000X.

When was this NPI record last updated?

The NPPES record for Michael Fuller was last updated on August 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.