MEDICARE: MRS. JUDITH DEE FIELDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	R302363	CA

General Provider Information

NPI Number	:	1164427845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDITH DEE FIELDS

Provider Business Mailing Address
First Line	:	PO BOX 2521
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-9521
Country	:	US
Telephone Number	:	916-965-4012
Fax Number	:	916-965-1082

Provider Business Practice Location Address
First Line	:	4125 TEMESCAL ST
Second Line	:	STE J
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-7558
Country	:	US
Telephone Number	:	916-965-4012
Fax Number	:	916-965-1082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	03/25/2013

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