Provider Demographics
NPI:1376850347
Name:FUENTES, KERRA LYNN
Entity Type:Individual
Prefix:MRS
First Name:KERRA
Middle Name:LYNN
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 1:4588 N RANCHO DR STE 12
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89130-3429
Mailing Address - Country:US
Mailing Address - Phone:702-415-1155
Mailing Address - Fax:702-396-6164
Practice Address - Street 1:4588 N RANCHO DR STE 12
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3429
Practice Address - Country:US
Practice Address - Phone:702-415-1155
Practice Address - Fax:702-396-6164
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner