Provider Demographics
NPI:1770941403
Name:FUENTES, BEATRIZ
Entity type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 S COLORADO ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85225-6311
Mailing Address - Country:US
Mailing Address - Phone:480-274-1613
Mailing Address - Fax:602-276-1984
Practice Address - Street 1:409 S COLORADO ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6311
Practice Address - Country:US
Practice Address - Phone:480-274-1613
Practice Address - Fax:602-276-1984
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5206683747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant