Provider Demographics
NPI:1770748592
Name:FUENTES, GERARDO MORENO
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:MORENO
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 1:1319 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2927
Mailing Address - Country:US
Mailing Address - Phone:510-535-2303
Mailing Address - Fax:510-535-2346
Practice Address - Street 1:425 VERNON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2927
Practice Address - Country:US
Practice Address - Phone:510-419-1040
Practice Address - Fax:510-419-1043
Is Sole Proprietor?:No
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor