Provider Demographics
NPI:1093479503
Name:FUENTES, RAYMOND (AGPCNP-C)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:AGPCNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7624 BOARDWALK
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:TX
Mailing Address - Zip Code:77657-6987
Mailing Address - Country:US
Mailing Address - Phone:409-330-1661
Mailing Address - Fax:
Practice Address - Street 1:3901 N TWIN CITY HWY
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-2118
Practice Address - Country:US
Practice Address - Phone:210-588-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056804363LX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0106XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health