Provider Demographics
NPI:1922327501
Name:FUENTES, ELSA G (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ELSA
Middle Name:G
Last Name:FUENTES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ELSA
Other - Middle Name:
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8113 ESTATE DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8130
Mailing Address - Country:US
Mailing Address - Phone:956-727-2292
Mailing Address - Fax:
Practice Address - Street 1:1911 NE BOB BULLOCK LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6596
Practice Address - Country:US
Practice Address - Phone:956-764-5050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-22
Last Update Date:2010-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX35893183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist