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General NPI Number Information
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NPI Number | 1659559136
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Entity Type | Organization
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Legal Business Name | FUENTES FAMILY COUNSELING, INC.
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/02/2021
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Provider Practice Location Address
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Address Line | 24230 BARTON RD
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City | LOMA LINDA
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State | CA
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Zip | 92354-3232
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Country | US
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Telephone | 909-796-9300
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10545
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0545
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Country | US
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Telephone | 909-248-4332
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSE FUENTES
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Credential | PH.D
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Telephone | 909-248-4332
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY19230
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License Number State | CA
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