Provider Demographics
NPI:1295212140
Name:FUENTES VEGA, NOHEMI
Entity Type:Individual
Prefix:
First Name:NOHEMI
Middle Name:
Last Name:FUENTES VEGA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 NIELSEN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-1024
Mailing Address - Country:US
Mailing Address - Phone:619-392-6119
Mailing Address - Fax:
Practice Address - Street 1:1727 SWEETWATER RD STE 117
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7651
Practice Address - Country:US
Practice Address - Phone:619-434-2063
Practice Address - Fax:619-336-0201
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOT18879225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist