Healthcare Provider Details

I. General information

NPI: 1962334516
Provider Name (Legal Business Name): GLORIA ESTEFANY FUENTES VALENCIA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32014 QUARTZ LN
CASTAIC CA
91384-3110
US

IV. Provider business mailing address

32014 QUARTZ LN
CASTAIC CA
91384-3110
US

V. Phone/Fax

Practice location:
  • Phone: 661-219-1946
  • Fax:
Mailing address:
  • Phone: 661-219-1946
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112996
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: