Provider Demographics
NPI:1356673685
Name:FUENTES, RUTH ALICIA (PA-C)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:ALICIA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:14442 WHITTIER BLVD
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90605-2107
Mailing Address - Country:US
Mailing Address - Phone:562-945-1940
Mailing Address - Fax:562-945-1855
Practice Address - Street 1:14442 WHITTIER BLVD
Practice Address - Street 2:SUITE # 105
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2107
Practice Address - Country:US
Practice Address - Phone:562-945-1940
Practice Address - Fax:562-945-2024
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20640363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical