Provider Demographics
NPI:1891194692
Name:FIELDS, ELLEN FEAD (CMP)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:FEAD
Last Name:FIELDS
Suffix:
Gender:F
Credentials:CMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 RIVERSIDE AVE STE 404
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-2682
Mailing Address - Country:US
Mailing Address - Phone:805-835-9798
Mailing Address - Fax:
Practice Address - Street 1:1111 RIVERSIDE AVE STE 404
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-2682
Practice Address - Country:US
Practice Address - Phone:805-835-9798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-18
Last Update Date:2019-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53469174400000X, 225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174400000XOther Service ProvidersSpecialist