Provider Demographics
NPI:1023334158
Name:FUSON, BILLY L JR
Entity type:Individual
Prefix:MR
First Name:BILLY
Middle Name:L
Last Name:FUSON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6656 ANTIGUA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124
Mailing Address - Country:US
Mailing Address - Phone:678-644-1007
Mailing Address - Fax:
Practice Address - Street 1:6656 ANTIGUA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124
Practice Address - Country:US
Practice Address - Phone:678-644-1007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
No1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman