Jerry Wallace Fulford

NPI #1427547355 in Capitola, California

Provider Information

NPI Number: 1427547355
Entity Type: Individual
Name: Jerry Wallace Fulford
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Massage Therapist
Enumeration Date: May 7, 2018
Last Updated: May 7, 2018

Practice Location

Address: 4170 GROSS RD. EXTENSION
Address 2: SUITE 6
City: Capitola
State: California
ZIP Code: 95010
Phone: (831) 464-1605

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Massage Therapist	225700000X	Primary

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