Individual
BRIDGET CARTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
275 BECK AVE # MS 5-250, FAIRFIELD, CA 94533-6804
(707) 759-0785
Mailing address
275 BECK AVE # MS 5-250, FAIRFIELD, CA 94533-6804
(707) 759-0785
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
172V00000X
Community Health Worker
Primary
—
—
225400000X
Rehabilitation Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
95-2633765
MEDI-CAL
CA
Enumeration date
08/12/2011
Last updated
06/01/2023
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