MEDICARE: DR. ALMA LEONELI FUENTES OD

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	152W00000X	Optometrist	60685047	WA
2	152W00000X	Optometrist	OPT36109-TLG	CA

General Provider Information

NPI Number	:	1316493158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALMA LEONELI FUENTES OD

Provider Business Mailing Address
First Line	:	3900 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2615
Country	:	US
Telephone Number	:	562-685-8605
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2615
Country	:	US
Telephone Number	:	562-685-8605
Fax Number	:

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

Provider Enumeration Date	:	08/31/2016
Last Update Date	:	12/02/2025

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