Provider Demographics
NPI:1700309267
Name:FUENTES, GUADALUPE
Entity Type:Individual
Prefix:MR
First Name:GUADALUPE
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16209 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHANNELVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:77530-4425
Mailing Address - Country:US
Mailing Address - Phone:832-581-1582
Mailing Address - Fax:
Practice Address - Street 1:16209 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHANNELVIEW
Practice Address - State:TX
Practice Address - Zip Code:77530-4425
Practice Address - Country:US
Practice Address - Phone:832-581-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program