Provider Demographics
NPI:1821588914
Name:FUENTES, JENNY (LVN)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:138 TREE FERN CT
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-2619
Mailing Address - Country:US
Mailing Address - Phone:805-427-4824
Mailing Address - Fax:
Practice Address - Street 1:138 TREE FERN CT
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2619
Practice Address - Country:US
Practice Address - Phone:805-427-4824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA695907164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse