Healthcare Provider Details

I. General information

NPI: 1760588420
Provider Name (Legal Business Name): CARRIE FIELDS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E SPRING ST SUITE #1
LONG BEACH CA
90806-1625
US

IV. Provider business mailing address

450 E SPRING ST SUITE 1
LONG BEACH CA
90806-1625
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0050
  • Fax:
Mailing address:
  • Phone: 562-933-0050
  • Fax: 562-933-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License Number20A6449
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number20A6449
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A6449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: