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General NPI Number Information
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NPI Number | 1013668334
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Entity Type | Individual
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Provider Name | CYD CHARISSE DIONALDO FUENTES RPH
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Gender | Female
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Dates
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Enumeration Date | 01/18/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 5100 LAGUNA BLVD
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City | ELK GROVE
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State | CA
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Zip | 95758-4159
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Country | US
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Telephone | 916-684-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 8668 SCARLET SAGE WAY
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City | ELK GROVE
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State | CA
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Zip | 95624-3853
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Country | US
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Telephone | 916-996-3273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH85517
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License Number State | CA
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