MEDICARE: MR. ARNULFO JR PUENTES

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1407041320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARNULFO JR PUENTES

Provider Business Mailing Address
First Line	:	4422 NE DEVILS LAKE BLVD
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5000
Country	:	US
Telephone Number	:	541-557-2700
Fax Number	:	541-994-0261

Provider Business Practice Location Address
First Line	:	4422 NE DEVILS LAKE BLVD
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5000
Country	:	US
Telephone Number	:	541-557-2700
Fax Number	:	541-994-0261

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

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	09/13/2007

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