Healthcare Provider Details

I. General information

NPI: 1861101529
Provider Name (Legal Business Name): MR. ALBERT THOMAS PUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 04/16/2025
Certification Date: 04/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 BANYAN CT
CERES CA
95307-1907
US

IV. Provider business mailing address

2935 4TH ST
CERES CA
95307-3222
US

V. Phone/Fax

Practice location:
  • Phone: 209-531-2088
  • Fax:
Mailing address:
  • Phone: 209-531-2088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: