Provider Demographics
NPI:1467469908
Name:FUENTES, ROSA A (MD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:A
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROSABER
Other - Middle Name:A
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6361 PARKLAND OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-5364
Mailing Address - Country:US
Mailing Address - Phone:210-213-4262
Mailing Address - Fax:
Practice Address - Street 1:7551 CALLAGHAN RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-920-5698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8V0062OtherBCBS OF TEXAS
TXP00321157OtherRR MEDICARE
TX118058005Medicaid
TXP00321157OtherRR MEDICARE
TX8G5323Medicare ID - Type Unspecified