Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | J3309 | TX |
NPI | 1013911544 |
---|---|
Provider Name | David Fuentes |
First Address | Boerne, TX 78006-2977 |
Second Address | Boerne, TX 78006-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2005 |
Last Update Date | 29/06/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
042756902 | (05) | TX |