Provider Demographics
NPI:1851684641
Name:FUENTES, HEATHER (DO)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:LYNN
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5262
Mailing Address - Fax:775-982-3901
Practice Address - Street 1:901 E 2ND ST STE 307
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1178
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-3901
Is Sole Proprietor?:No
Enumeration Date:2011-05-26
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.011323207V00000X
VA0102205331207V00000X
NVDO2928207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology