1003071051 NPI number — ADELE ALEXANDRA FIELDS MD

Table of content: ADELE ALEXANDRA FIELDS MD (NPI 1003071051)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003071051 NPI number — ADELE ALEXANDRA FIELDS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIELDS
Provider First Name:
ADELE
Provider Middle Name:
ALEXANDRA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WOYTAK
Provider Other First Name:
ADELE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003071051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 678510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75267-8510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-475-3698
Provider Business Mailing Address Fax Number:
719-591-2745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 E HERNDON AVE STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRESNO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93720-3333
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-450-6742
Provider Business Practice Location Address Fax Number:
559-450-6743
Provider Enumeration Date:
07/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  C167040 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1003071051 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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