Provider Demographics
NPI:1740666569
Name:FUENTES, CARLOS (FNP)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 N MESA ST STE F
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3575
Mailing Address - Country:US
Mailing Address - Phone:915-544-6400
Mailing Address - Fax:915-544-2836
Practice Address - Street 1:2311 N MESA ST STE F
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3575
Practice Address - Country:US
Practice Address - Phone:915-544-6400
Practice Address - Fax:915-544-2836
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX827261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse