Provider Demographics
NPI:1457064578
Name:FUENTEZ, ANGELINA LINETTE (SUD COUNSELOR)
Entity Type:Individual
Prefix:
First Name:ANGELINA
Middle Name:LINETTE
Last Name:FUENTEZ
Suffix:
Gender:F
Credentials:SUD COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 CORSON AVE
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-5408
Mailing Address - Country:US
Mailing Address - Phone:209-521-1805
Mailing Address - Fax:
Practice Address - Street 1:416 CORSON AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-5408
Practice Address - Country:US
Practice Address - Phone:209-521-1805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)