Healthcare Provider Details

I. General information

NPI: 1730510892
Provider Name (Legal Business Name): DAISY FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2013
Last Update Date: 11/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 CHEROKEE DR
DOWNEY CA
90241-2124
US

IV. Provider business mailing address

7450 CHEROKEE DR
DOWNEY CA
90241-2124
US

V. Phone/Fax

Practice location:
  • Phone: 562-522-4480
  • Fax:
Mailing address:
  • Phone: 562-522-4480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number090182842
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: