Provider Demographics
NPI:1942828785
Name:FUERTE, ISABELLA L
Entity Type:Individual
Prefix:
First Name:ISABELLA
Middle Name:L
Last Name:FUERTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2011 ARDEN AVE APT 204
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND
Mailing Address - State:CA
Mailing Address - Zip Code:92346-5127
Mailing Address - Country:US
Mailing Address - Phone:909-486-4347
Mailing Address - Fax:
Practice Address - Street 1:2011 ARDEN AVE APT 204
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-5127
Practice Address - Country:US
Practice Address - Phone:909-486-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty