Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Elizabeth Wagner Fulp, PA

Individual provider Medical Physician Assistant · NPI 1548994171

Elizabeth Wagner Fulp, PA is a Physician Assistant in San Diego, California. Graduated from University of Southern California Keck School of Medicine in 2024, 2 years ago. Licensed in California.

Years since qualifying
2
Trained at
University of Southern California Keck School of Medicine
Licensed in
CA
In the registry since
2022
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

3020 Childrens Way
San Diego, CA 92123-4223
Phone: (858) 966-8800
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA64929 (CA)

Record details

NPI number1548994171
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 11, 2022
Last updated in NPPESNovember 4, 2024
Certification dateNovember 4, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolUNIVERSITY OF SOUTHERN CALIFORNIA KECK SCHOOL OF MEDICINE
Graduated 2024 (2 years in practice)
Accepts Medicare assignment Not indicated

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