Provider Demographics
NPI:1376918813
Name:FUENTES, BRITTANY MARIE
Entity Type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:MARIE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:MARIE
Other - Last Name:MRAZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 REGULO PL APT 1438
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-7717
Mailing Address - Country:US
Mailing Address - Phone:831-869-8874
Mailing Address - Fax:
Practice Address - Street 1:909 A BLANCO CIRCLE
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901
Practice Address - Country:US
Practice Address - Phone:831-424-5033
Practice Address - Fax:831-424-5044
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator