Provider Demographics
NPI:1407383946
Name:MCMULLEN FIELDS, OLIVIA CAROLINE (LAC)
Entity Type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CAROLINE
Last Name:MCMULLEN FIELDS
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 S BARRINGTON AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6422
Mailing Address - Country:US
Mailing Address - Phone:310-948-1284
Mailing Address - Fax:
Practice Address - Street 1:401 S BARRINGTON AVE APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6422
Practice Address - Country:US
Practice Address - Phone:310-948-1284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17609171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist