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General NPI Number Information
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NPI Number | 1336295997
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Entity Type | Individual
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Provider Name | STEPHEN MARK PUENTES MD
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Gender | Male
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Dates
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Enumeration Date | 01/26/2007
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Last Update Date | 03/24/2010
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Provider Practice Location Address
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Address Line | 5850 S MAIN ST ROOM 1127
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City | LOS ANGELES
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State | CA
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Zip | 90003-1215
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Country | US
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Telephone | 323-846-4219
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Fax | 323-238-0210
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Provider Business Mailing Address
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Address Line | 8902 WOODMAN AVE
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City | ARLETA
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State | CA
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Zip | 91331-6401
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Country | US
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Telephone | 818-830-7033
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Fax | 818-830-7280
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | G63475
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License Number State | CA
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