Healthcare Provider Details

I. General information

NPI: 1881325678
Provider Name (Legal Business Name): LESLEY KIM FUENTES OTD, OTR/L
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2022
Last Update Date: 02/22/2026
Certification Date: 02/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 PARK SHADOW CT
BALDWIN PARK CA
91706-3257
US

IV. Provider business mailing address

228 PARK SHADOW CT
BALDWIN PARK CA
91706-3257
US

V. Phone/Fax

Practice location:
  • Phone: 626-678-4538
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number24362
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: