Basic Information
| Provider Information | |||||||||
| NPI: | 1376755199 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FUENTES | ||||||||
| FirstName: | FELMA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 45104 10TH ST W | ||||||||
| Address2: | |||||||||
| City: | LANCASTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935342310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6619422391 | ||||||||
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| Practice Location | |||||||||
| Address1: | 626 MAIN STREET | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 932152934 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6617218800 | ||||||||
| FaxNumber: | 6617218810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 10/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 170100000X | C42076 | CA | N | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics | 170100000X | CA | N | Other Service Providers | Medical Genetics, Ph.D. Medical Genetics | 208000000X | 42076 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | GR0083054 | 05 | CA | MEDICAID | 770468890 | 05 | CA | MEDICAID | C42076 | 05 | CA | MEDICAID |