MEDICARE: NICELE E. PUENTE MD

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
1	207Q00000X	Family Medicine Physician	A170386	CA

General Provider Information

NPI Number	:	1225569866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICELE E. PUENTE MD

Provider Business Mailing Address
First Line	:	11858 HARVEST DR
Second Line	:
City	:	WHITTIER
State	:	CA
Zip	:	90602-1089
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2015 W 1ST ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92703-3536
Country	:	US
Telephone Number	:	714-716-1830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2017
Last Update Date	:	11/30/2021

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Directions to “ NICELE E. PUENTE MD” Practice Location

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