Provider Demographics
NPI:1811070261
Name:FUENTES, MARIA GERALDINA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:GERALDINA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:717 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-5803
Mailing Address - Country:US
Mailing Address - Phone:619-941-1545
Mailing Address - Fax:619-941-1558
Practice Address - Street 1:717 3RD AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-5803
Practice Address - Country:US
Practice Address - Phone:619-941-1545
Practice Address - Fax:619-941-1558
Is Sole Proprietor?:No
Enumeration Date:2006-10-21
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83896207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFD838AMedicare PIN