Provider Demographics
NPI:1255484374
Name:FAIRFULL, CARYL B (RD)
Entity Type:Individual
Prefix:MRS
First Name:CARYL
Middle Name:B
Last Name:FAIRFULL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11622 CEMENT HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-9061
Mailing Address - Country:US
Mailing Address - Phone:530-470-0870
Mailing Address - Fax:530-470-0870
Practice Address - Street 1:11622 CEMENT HILL RD
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-9061
Practice Address - Country:US
Practice Address - Phone:530-470-0870
Practice Address - Fax:530-470-0870
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered