Provider Demographics
NPI:1013590504
Name:FUENTES, RODOLFO (NP)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6157 NW LOOP 410 STE 124
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-3302
Mailing Address - Country:US
Mailing Address - Phone:210-523-1411
Mailing Address - Fax:210-523-9307
Practice Address - Street 1:6157 NW LOOP 410 STE 124
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-3302
Practice Address - Country:US
Practice Address - Phone:210-523-1411
Practice Address - Fax:210-523-9307
Is Sole Proprietor?:No
Enumeration Date:2021-05-03
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1036005363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner