Healthcare Provider Details

I. General information

NPI: 1215934096
Provider Name (Legal Business Name): CARLA ANNA FISHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LYNCH CREEK WAY
PETALUMA CA
94954-2343
US

IV. Provider business mailing address

500 ALFRED NOBEL DR SUITE 245
HERCULES CA
94547-1838
US

V. Phone/Fax

Practice location:
  • Phone: 707-762-5531
  • Fax: 707-762-5976
Mailing address:
  • Phone: 510-741-7299
  • Fax: 510-741-7493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG63183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: