Provider Demographics
NPI:1376755199
Name:FUENTES, FELMA (MD)
Entity Type:Individual
Prefix:
First Name:FELMA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45104 10TH ST W
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-2310
Mailing Address - Country:US
Mailing Address - Phone:661-942-2391
Mailing Address - Fax:
Practice Address - Street 1:626 MAIN STREET
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93215-2934
Practice Address - Country:US
Practice Address - Phone:661-721-8800
Practice Address - Fax:661-721-8810
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC42076170100000X
CA170100000X
CA42076208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083054Medicaid
CA770468890Medicaid
CAC42076Medicaid