MEDICARE: ALEXIS MARIE FUENTES MAS-MFT

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	106H00000X	Marriage & Family Therapist		AZ

General Provider Information

NPI Number	:	1487510558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXIS MARIE FUENTES MAS-MFT

Provider Business Mailing Address
First Line	:	1600 W LA JOLLA DR APT 2239
Second Line	:
City	:	TEMPE
State	:	AZ
Zip	:	85282-4492
Country	:	US
Telephone Number	:	480-359-7876
Fax Number	:

Provider Business Practice Location Address
First Line	:	9410 E CADENCE PKWY APT 1146
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85212-0107
Country	:	US
Telephone Number	:	480-359-7876
Fax Number	:

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

Provider Enumeration Date	:	01/01/2026
Last Update Date	:	01/01/2026

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