Healthcare Provider Details

I. General information

NPI: 1376918813
Provider Name (Legal Business Name): MRS. BRITTANY MARIE FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRITTANY MARIE MRAZ

II. Dates (important events)

Enumeration Date: 12/09/2015
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 A BLANCO CIRCLE
SALINAS CA
93901
US

IV. Provider business mailing address

805 REGULO PL APT 1438
CHULA VISTA CA
91910-7717
US

V. Phone/Fax

Practice location:
  • Phone: 831-424-5033
  • Fax: 831-424-5044
Mailing address:
  • Phone: 831-869-8874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: