Provider Demographics
NPI:1326603077
Name:FUENTES, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:FUENTES
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 1:749 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-5124
Mailing Address - Country:US
Mailing Address - Phone:844-322-7483
Mailing Address - Fax:888-334-7021
Practice Address - Street 1:15478 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3002
Practice Address - Country:US
Practice Address - Phone:844-322-7483
Practice Address - Fax:888-334-7021
Is Sole Proprietor?:No
Enumeration Date:2019-05-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician