IndividualActive
Michael Fuller
NPI 1083084115 · Rehabilitation Practitioner · Beaumont, CA
Provider details
- NPI number
- 1083084115
- Entity type
- Individual
- Primary specialty
- Rehabilitation PractitionerRespiratory, Developmental, Rehabilitative and Restorative Service Providers
- Sex
- Male
- Sole proprietor
- Yes
- License
- 17771 (CA)
Specialties & taxonomies
Respiratory, Developmental, Rehabilitative and Restorative Service Providers
Behavioral Health & Social Service Providers
Profile Score
Detailed profile(78/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
2 documented practice locations
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
14763 Manzanita Rd
Beaumont, CA 92223-3026
Phone: (909) 433-9824
Street-level locationGet directions
Mailing address
1076 Santo Antonio Dr
Colton, CA 92324-8103
Additional practice locations (1)
- 1076 Santo Antonio DrColton, CA 92324-8103Phone: (909) 433-9824
Registry dates
- Enumerated
- 2015-10-01
- Last updated
- 2025-08-21
- Certified
- 2025-08-21
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.