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

Michael Charles Fuller Jr.

Individual provider Rehabilitation Practitioner · NPI 1083084115

Michael Charles Fuller Jr. is a Rehabilitation Practitioner in Beaumont, California. Practices as a sole proprietor and works from 2 locations. Licensed in California.

Licensed in
CA
In the registry since
2015
Specialties on file
2

Practice location Address checks out

14763 Manzanita Rd
Beaumont, CA 92223-3026
Phone: (909) 433-9824
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1076 Santo Antonio Dr, Colton, CA 92324-8103 — (909) 433-9824

Specialties & licences

Rehabilitation Practitioner (primary) Taxonomy 225400000X · Licence 17771 (CA)
Addiction (Substance Use Disorder) Counselor Taxonomy 101YA0400X · Licence 17771 (CA)

Record details

NPI number1083084115
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedOctober 1, 2015
Last updated in NPPESAugust 21, 2025
Certification dateAugust 21, 2025
Mailing address1076 Santo Antonio Dr, Colton, CA 92324-8103

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