Healthcare Provider Details

I. General information

NPI: 1376755199
Provider Name (Legal Business Name): FELMA FUENTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

626 MAIN STREET
BAKERSFIELD CA
93215-2934
US

IV. Provider business mailing address

45104 10TH ST W
LANCASTER CA
93534-2310
US

V. Phone/Fax

Practice location:
  • Phone: 661-721-8800
  • Fax: 661-721-8810
Mailing address:
  • Phone: 661-942-2391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License NumberC42076
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number42076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: