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NPI Code Detail

MEDICARE: EDWARD RAYMOND FUENTES JR.

MEDICARE: EDWARD RAYMOND FUENTES JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist105637CA

General Provider Information

NPI Number : 1063842631
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD RAYMOND FUENTES JR.
Provider Business Mailing Address
First Line : 401 E. IMPERIAL HWY
Second Line :
City : FULLERTON
State : CA
Zip : 92835-1145
Country : US
Telephone Number : 714-447-7000
Fax Number :
Provider Business Practice Location Address
First Line : 401 E. IMPERIAL HWY
Second Line :
City : FULLERTON
State : CA
Zip : 92835-1145
Country : US
Telephone Number : 714-447-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2013
Last Update Date : 05/18/2020

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Directions to “ EDWARD RAYMOND FUENTES JR. ” Practice Location

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