Healthcare Provider Details

I. General information

NPI: 1568053866
Provider Name (Legal Business Name): STEVEN RAY FUENTES PHARMD,RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: STEVEN RAY FUENTES PHARMD, RPH

II. Dates (important events)

Enumeration Date: 01/29/2021
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3011 N MAIN ST
LAS CRUCES NM
88001-1164
US

IV. Provider business mailing address

3011 N MAIN ST
LAS CRUCES NM
88001-1164
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-8878
  • Fax:
Mailing address:
  • Phone: 575-647-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number69313
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number77383
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9495
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: