Basic Information
| Provider Information | |||||||||
| NPI: | 1780333120 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUENTES | ||||||||
| FirstName: | STANLEY MELCHOR | ||||||||
| MiddleName: | CAPULONG | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 521 SWIFT FOX RUN | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704473119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045687912 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 521 SWIFT FOX RUN | ||||||||
| Address2: | |||||||||
| City: | MADISONVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 704473119 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5045687912 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2022 | ||||||||
| LastUpdateDate: | 03/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.