Healthcare Provider Details

I. General information

NPI: 1316493158
Provider Name (Legal Business Name): ALMA LEONELI FUENTES OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3900 LONG BEACH BLVD
LONG BEACH CA
90807-2615
US

IV. Provider business mailing address

3900 LONG BEACH BLVD
LONG BEACH CA
90807-2615
US

V. Phone/Fax

Practice location:
  • Phone: 562-685-8605
  • Fax:
Mailing address:
  • Phone: 562-685-8605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60685047
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT36109-TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: