Provider Demographics
NPI:1649477837
Name:TURNBULL, FREDERICK DEWITT III
Entity type:Individual
Prefix:MR
First Name:FREDERICK
Middle Name:DEWITT
Last Name:TURNBULL
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-3814
Mailing Address - Country:US
Mailing Address - Phone:530-877-3535
Mailing Address - Fax:
Practice Address - Street 1:746 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3814
Practice Address - Country:US
Practice Address - Phone:530-877-3535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA150726164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAM0964855OtherCALIF DMV LIC. #
CAC6650OtherUSPA LIC#
CA150726OtherLVN LIC #
CARVN005110Medicaid
CAEPS017000Medicaid