Provider Demographics
NPI:1952475428
Name:FUERTEZ, ROLAND MUSNGI (MD)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:MUSNGI
Last Name:FUERTEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41789 NICOLE LN STE B3
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-3871
Mailing Address - Country:US
Mailing Address - Phone:951-699-3796
Mailing Address - Fax:
Practice Address - Street 1:41789 NICOLE LN STE B3
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-3871
Practice Address - Country:US
Practice Address - Phone:951-699-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA102508207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine