Provider Demographics
NPI:1568806560
Name:PUENTES, JOSEPH CHRISTOPHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:CHRISTOPHER
Last Name:PUENTES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 BENNETT VALLEY RD
Mailing Address - Street 2:WATERFALL TOWERS SUITE B-208
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-5663
Mailing Address - Country:US
Mailing Address - Phone:707-583-9663
Mailing Address - Fax:
Practice Address - Street 1:2455 BENNETT VALLEY RD
Practice Address - Street 2:WATERFALL TOWERS SUITE B-208
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-5663
Practice Address - Country:US
Practice Address - Phone:707-583-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-20
Last Update Date:2013-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25330103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical