Healthcare Provider Details

I. General information

NPI: 1861048746
Provider Name (Legal Business Name): NANCY PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 E 1ST ST
LONG BEACH CA
90802-4903
US

IV. Provider business mailing address

PO BOX 310405
FONTANA CA
92331-0405
US

V. Phone/Fax

Practice location:
  • Phone: 562-888-0386
  • Fax:
Mailing address:
  • Phone: 909-434-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number154475
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: