Provider Demographics
NPI:1679116859
Name:FUENTES, REBECCA (NP STUDENT)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:NP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 JOSHUA CREEK PL
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2600
Mailing Address - Country:US
Mailing Address - Phone:619-948-3173
Mailing Address - Fax:
Practice Address - Street 1:1061 TIERRA DEL REY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-7880
Practice Address - Country:US
Practice Address - Phone:619-498-5454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-21
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program