Provider Demographics
NPI:1508503657
Name:FUENTES, MONICA KARINA (RD LD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:KARINA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:RD LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9535 WINDFERN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-7722
Mailing Address - Country:US
Mailing Address - Phone:713-480-1167
Mailing Address - Fax:
Practice Address - Street 1:9535 WINDFERN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-7722
Practice Address - Country:US
Practice Address - Phone:713-480-1167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT80758133V00000X
IL1014471133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered