Provider Demographics
NPI:1437372372
Name:FIELDS, MARIA VICTORIA TAGAL
Entity Type:Individual
Prefix:
First Name:MARIA VICTORIA
Middle Name:TAGAL
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 1:32576 VIA DESTELLO
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-3964
Mailing Address - Country:US
Mailing Address - Phone:951-699-6332
Mailing Address - Fax:
Practice Address - Street 1:1401 DESHLER ST SW
Practice Address - Street 2:
Practice Address - City:FORT MCPHERSON
Practice Address - State:GA
Practice Address - Zip Code:30330-1040
Practice Address - Country:US
Practice Address - Phone:770-968-6340
Practice Address - Fax:678-422-9346
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010809931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical