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General NPI Number Information
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NPI Number | 1023416526
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Entity Type | Individual
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Provider Name | FATIMA LISETTE FUENTES
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Gender | Female
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Dates
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Enumeration Date | 12/15/2014
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Last Update Date | 12/15/2014
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Provider Practice Location Address
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Address Line | 1470 CIVIC CT SUITE 111
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City | CONCORD
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State | CA
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Zip | 94520-5290
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Country | US
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Telephone | 925-215-3561
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Fax | 925-429-9041
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Provider Business Mailing Address
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Address Line | 1850 GATEWAY BLVD SUITE 900
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City | CONCORD
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State | CA
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Zip | 94520-3279
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Country | US
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Telephone | 925-215-3561
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Fax | 925-429-9041
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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