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General NPI Number Information
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NPI Number | 1720370380
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Entity Type | Organization
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Legal Business Name | JULIAN R FUENTES MD INC
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 3330 CHURN CREEK RD STE D4
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City | REDDING
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State | CA
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Zip | 96002-2532
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Country | US
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Telephone | 530-222-3287
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Fax | 530-222-8547
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Provider Business Mailing Address
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Address Line | PO BOX 991868
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City | REDDING
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State | CA
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Zip | 96099-1868
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Country | US
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Telephone | 530-339-0025
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Fax | 530-722-9095
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Authorized Official
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Title or Position | PRESIDENT
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Name | JULIAN FUENTES
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Credential | MD
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Telephone | 530-222-3287
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A50122
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License Number State | CA
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