Provider Demographics
NPI:1780333120
Name:FUENTES, STANLEY MELCHOR CAPULONG (MD)
Entity type:Individual
Prefix:DR
First Name:STANLEY MELCHOR
Middle Name:CAPULONG
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SWIFT FOX RUN
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70447-3119
Mailing Address - Country:US
Mailing Address - Phone:504-568-7912
Mailing Address - Fax:
Practice Address - Street 1:521 SWIFT FOX RUN
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-3119
Practice Address - Country:US
Practice Address - Phone:504-568-7912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program