Healthcare Provider Details

I. General information

NPI: 1710697255
Provider Name (Legal Business Name): ALEJANDRO FUENTES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/23/2022
Certification Date: 11/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALZ. DE LAS AMERICAS 62 CUAUHTEMOC SUR
MEXICALI BAJA CALIFORNIA
21200
MX

IV. Provider business mailing address

84640 ROMERO ST
COACHELLA CA
92236-1367
US

V. Phone/Fax

Practice location:
  • Phone: 619-270-9021
  • Fax: 619-329-9663
Mailing address:
  • Phone: 686-189-3940
  • Fax: 619-329-9663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEJANDRO FUENTES
Title or Position: DENTIST
Credential: DDS
Phone: 619-272-9021