Healthcare Provider Details

I. General information

NPI: 1255120796
Provider Name (Legal Business Name): LIZETH FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LIZETH MUNOZ GARCIA

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 E 4TH ST
SANTA ANA CA
92705-3916
US

IV. Provider business mailing address

2001 E 4TH ST
SANTA ANA CA
92705-3916
US

V. Phone/Fax

Practice location:
  • Phone: 714-824-8140
  • Fax: 714-824-8142
Mailing address:
  • Phone: 714-824-8140
  • Fax: 714-824-8142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW139529
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: