Provider Demographics
NPI:1164427845
Name:FIELDS, JUDITH DEE
Entity Type:Individual
Prefix:MRS
First Name:JUDITH
Middle Name:DEE
Last Name:FIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2521
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-9521
Mailing Address - Country:US
Mailing Address - Phone:916-965-4012
Mailing Address - Fax:916-965-1082
Practice Address - Street 1:4125 TEMESCAL ST
Practice Address - Street 2:STE J
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7558
Practice Address - Country:US
Practice Address - Phone:916-965-4012
Practice Address - Fax:916-965-1082
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR302363133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ22487ZMedicare ID - Type Unspecified
ZZZ22488ZMedicare ID - Type Unspecified
P52282Medicare UPIN
ZZZ22487ZMedicare UPIN
ZZZ22488ZMedicare UPIN