Individual
IDA R FIELDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
22131 MIRAMOT RD, APPLE VALLEY, CA 92308-7394
(760) 217-5187
Mailing address
22131 MIRAMOT RD, APPLE VALLEY, CA 92308-7394
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
E31922210
CA
Other
Enumeration date
01/10/2024
Last updated
01/10/2024
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