Provider Demographics
NPI:1407530942
Name:FUENTES ROSALES, VIRIDIANA (NP)
Entity Type:Individual
Prefix:
First Name:VIRIDIANA
Middle Name:
Last Name:FUENTES ROSALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 GROVER GLEN CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6021
Mailing Address - Country:US
Mailing Address - Phone:818-926-1660
Mailing Address - Fax:
Practice Address - Street 1:4122 GROVER GLEN CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6021
Practice Address - Country:US
Practice Address - Phone:818-926-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP00006975363LF0000X
CA95022021363LF0000X
VA0024186069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCNP00006975OtherDC HEALTH BOARD OF NURSING
VA0024186069OtherVIRGINIA BOARD OF NURSING
CA95022021OtherCALIFORNIA BOARD OF REGISTERED NURSING