Healthcare Provider Details

I. General information

NPI: 1740359967
Provider Name (Legal Business Name): RICHARD FELL CARPENTER NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 SAN ELIJO AVENUE
CARDIFF BY THE SEA CA
92007
US

IV. Provider business mailing address

2045 SAN ELIJO AVENUE
CARDIFF BY THE SEA CA
92007
US

V. Phone/Fax

Practice location:
  • Phone: 760-944-8877
  • Fax: 760-944-8897
Mailing address:
  • Phone: 760-944-8877
  • Fax: 760-944-8897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number17048
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000606
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: