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NPI Code Detail

MEDICARE: LEA FUENTES RN

MEDICARE: LEA FUENTES RN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse12049689-3102UT

General Provider Information

NPI Number : 1558299297
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEA FUENTES RN
Provider Business Mailing Address
First Line : 952 E DESERT CACTUS DR
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-3559
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 952 E DESERT CACTUS DR
Second Line :
City : WASHINGTON
State : UT
Zip : 84780-3559
Country : US
Telephone Number : 805-551-7829
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2026
Last Update Date : 05/12/2026

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Directions to “ LEA FUENTES RN” Practice Location

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