Active NPI
Candace Merita Fortune, MD
- Child & Adolescent Psychiatry Physician
- Folsom, CA
National Provider Identifier
1447360482
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- A69812
- Practice address
- 785 Orchard Dr
Suite 100
Folsom, CA 95630-5557 - Phone
- (916) 984-4300
- Fax
- (916) 984-4334
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A69812 | CA | |
| Child & Adolescent Psychiatry Physician | 2084P0804X | A69812 | CA | Primary |
Addresses
Primary practice location
785 Orchard Dr
Suite 100
Folsom, CA 95630-5557
Mailing address
5480 Sur Mer Dr
El Dorado Hills, CA 95762-7653
Phone (707) 235-9928
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A69812 | CA | MD | Child & Adolescent Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156896000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287014400000",
"number": "1447360482",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5480 SUR MER DR",
"city": "EL DORADO HILLS",
"state": "CA",
"postal_code": "957627653",
"telephone_number": "707-235-9928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "785 ORCHARD DR",
"address_2": "SUITE 100",
"city": "FOLSOM",
"state": "CA",
"postal_code": "956305557",
"telephone_number": "916-984-4300",
"fax_number": "916-984-4334"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FORTUNE",
"first_name": "CANDACE",
"middle_name": "MERITA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-30",
"last_updated": "2010-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A69812",
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "CA",
"license": "A69812",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Folsom, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.