MEDICARE: BRIANA FUENTES

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	106S00000X	Behavior Technician	510845617	NM

General Provider Information

NPI Number	:	1780538157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIANA FUENTES

Provider Business Mailing Address
First Line	:	612 LAS MARIAS DR SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1269
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:

Provider Business Practice Location Address
First Line	:	612 LAS MARIAS DR SE
Second Line	:
City	:	RIO RANCHO
State	:	NM
Zip	:	87124-1269
Country	:	US
Telephone Number	:	718-215-5311
Fax Number	:

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

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “ BRIANA FUENTES ” Practice Location

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