Provider Demographics
NPI:1932307485
Name:FUENTES, MARITESS GARCIA (MD)
Entity Type:Individual
Prefix:
First Name:MARITESS
Middle Name:GARCIA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21890 W. COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOAQUIN
Mailing Address - State:CA
Mailing Address - Zip Code:93660
Mailing Address - Country:US
Mailing Address - Phone:559-693-2398
Mailing Address - Fax:
Practice Address - Street 1:689 N ST
Practice Address - Street 2:
Practice Address - City:FIREBAUGH
Practice Address - State:CA
Practice Address - Zip Code:93622-2156
Practice Address - Country:US
Practice Address - Phone:559-659-3037
Practice Address - Fax:559-659-3464
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111637207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine