Healthcare Provider Details

I. General information

NPI: 1356934707
Provider Name (Legal Business Name): BERNADETTTE FUENTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2021
Last Update Date: 06/14/2026
Certification Date: 06/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 E HOSPITALITY LN STE 400
SAN BERNARDINO CA
92408-3545
US

IV. Provider business mailing address

41990 COOK ST STE 801A
PALM DESERT CA
92211-6103
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0862
  • Fax:
Mailing address:
  • Phone: 442-666-3217
  • 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: