Provider Demographics
NPI:1003271149
Name:TOVAR FUENTES, LORENA LLANET (PMHNP)
Entity Type:Individual
Prefix:
First Name:LORENA
Middle Name:LLANET
Last Name:TOVAR FUENTES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:LORENA
Other - Middle Name:LLANET
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:415 W ROUTE 66 STE 202
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-4335
Mailing Address - Country:US
Mailing Address - Phone:626-963-4467
Mailing Address - Fax:626-963-9543
Practice Address - Street 1:415 W ROUTE 66 STE 202
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4335
Practice Address - Country:US
Practice Address - Phone:626-963-4467
Practice Address - Fax:626-963-9543
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764782163WP0808X
CA95011859363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health