Healthcare Provider Details

I. General information

NPI: 1295607109
Provider Name (Legal Business Name): JESUS FUENTES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 10/24/2025
Certification Date: 09/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1604 SUNRISE AVE
MADERA CA
93638-4926
US

IV. Provider business mailing address

1604 SUNRISE AVE
MADERA CA
93638-4926
US

V. Phone/Fax

Practice location:
  • Phone: 559-675-7893
  • Fax:
Mailing address:
  • Phone: 559-871-7893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: