Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 565 | CA |
NPI | 1144795501 |
---|---|
Provider Name | Tessa Marie Fisher |
First Address | Westminster, CA 92683-4147 |
Second Address | Westminster, CA 92683-4147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2018 |
Last Update Date | 02/04/2019 |