Provider Demographics
NPI:1396898623
Name:FUENTES, JOSEPH MANUEL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MANUEL
Last Name:FUENTES
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 1:6514 LUCILLE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-2120
Mailing Address - Country:US
Mailing Address - Phone:443-691-6700
Mailing Address - Fax:
Practice Address - Street 1:6514 LUCILLE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-2120
Practice Address - Country:US
Practice Address - Phone:443-691-6700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program