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General NPI Number Information
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NPI Number | 1518278811
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Entity Type | Individual
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Provider Name | MRS. ELIDA FUENTES
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Gender | Female
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 03/25/2021
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Provider Practice Location Address
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Address Line | 14623 HAWTHORNE BLVD STE 400
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City | LAWNDALE
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State | CA
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Zip | 90260-1581
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Country | US
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Telephone | 310-970-5000
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Fax |
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Provider Business Mailing Address
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Address Line | 420 E 3RD ST STE 910
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City | LOS ANGELES
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State | CA
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Zip | 90013-1647
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Country | US
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Telephone | 213-434-7791
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 34109
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW 34109
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 225400000X
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Taxonomy Name | Rehabilitation Practitioner
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License Number |
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License Number State |
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