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General NPI Number Information
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NPI Number | 1508153297
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Entity Type | Organization
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Legal Business Name | MARIA GERALDINA FUENTES MD INC
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 05/20/2014
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Provider Practice Location Address
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Address Line | 717 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-5803
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Country | US
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Telephone | 619-941-1545
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Fax | 619-941-1558
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Provider Business Mailing Address
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Address Line | 717 3RD AVE
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City | CHULA VISTA
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State | CA
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Zip | 91910-5803
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Country | US
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Telephone | 619-941-1545
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Fax | 619-941-1558
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIA GERALDINA FUENTES
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Credential | M.D.
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Telephone | 619-941-1545
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A83896
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License Number State | CA
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