Provider Demographics
NPI:1477796894
Name:FITZPATRICK, CARMELLA LOUISE (LVN)
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:LOUISE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LVN
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 232503
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92023-2503
Mailing Address - Country:US
Mailing Address - Phone:760-846-3001
Mailing Address - Fax:
Practice Address - Street 1:8939 VILLA LA JOLLA DR
Practice Address - Street 2:SUITE 210 MAIL CODE 0945
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1732
Practice Address - Country:US
Practice Address - Phone:858-657-7234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-15
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN222223164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse