Provider Demographics
NPI:1053637918
Name:FUENTES, JANICE RAQUEL (MD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:RAQUEL
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:RAQUEL
Other - Last Name:FUENTES DELGADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:24671 MONROE AVE # C102
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-9589
Mailing Address - Country:US
Mailing Address - Phone:619-306-1127
Mailing Address - Fax:833-989-2495
Practice Address - Street 1:24671 MONROE AVE # C102
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9589
Practice Address - Country:US
Practice Address - Phone:951-797-4446
Practice Address - Fax:833-989-2495
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1188212084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology