Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | CA | |
N | 170100000X | Medical Geneticist | C42076 | CA |
Y | 208000000X | Pediatrician | 42076 | CA |
NPI | 1376755199 |
---|---|
Provider Name | Felma Fuentes |
First Address | Lancaster, CA 93534-2310 |
Second Address | Bakersfield, CA 93215-2934 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/05/2007 |
Last Update Date | 30/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
770468890 | (05) | CA |
C42076 | (05) | CA |
GR0083054 | (05) | CA |