Healthcare Provider Details

I. General information

NPI: 1346076999
Provider Name (Legal Business Name): ANNIE MARIE FOWLER MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

IV. Provider business mailing address

2420 MARTIN RD STE 200
FAIRFIELD CA
94534-8610
US

V. Phone/Fax

Practice location:
  • Phone: 707-770-9551
  • Fax:
Mailing address:
  • Phone: 707-770-9551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW131052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: