Provider Demographics
NPI:1528386471
Name:FUENTES, CARLOS ALBERTO (RPH, ABOC)
Entity Type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:ALBERTO
Last Name:FUENTES
Suffix:
Gender:M
Credentials:RPH, ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7811 MCPHERSON RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-2802
Mailing Address - Country:US
Mailing Address - Phone:956-712-8053
Mailing Address - Fax:
Practice Address - Street 1:7917 MCPHERSON RD STE 206
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-2812
Practice Address - Country:US
Practice Address - Phone:956-693-0899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-16
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36772183500000X
TX216467156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No183500000XPharmacy Service ProvidersPharmacist