Basic Information
| Provider Information | |||||||||
| NPI: | 1801073440 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUENTES | ||||||||
| FirstName: | ADRIANA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RN, BSN, PHN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15317 GEORGIA AVE. | ||||||||
| Address2: | |||||||||
| City: | PARAMOUNT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90723 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626304584 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 14180 BEACH BLVD | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926834452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7148967800 | ||||||||
| FaxNumber: | 7148967808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2008 | ||||||||
| LastUpdateDate: | 01/25/2008 | ||||||||
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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 | 163W00000X | 68774 | CA | N | Nursing Service Providers | Registered Nurse | 163WC1500X | 68774 | CA | Y | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.