| Maria Geraldina Fuentes Md Inc | |
|
717 3rd Ave Chula Vista CA 91910-5803 | |
| (619) 941-1545 | |
| (619) 941-1558 |
| Full Name | Maria Geraldina Fuentes Md Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 717 3rd Ave, Chula Vista, California |
| Authorized Official Name and Position | Maria Geraldina Fuentes (PRESIDENT) |
| Authorized Official Contact | 6199411545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maria Geraldina Fuentes Md Inc 717 3rd Ave Chula Vista CA 91910-5803 Ph: (619) 941-1545 | Maria Geraldina Fuentes Md Inc 717 3rd Ave Chula Vista CA 91910-5803 Ph: (619) 941-1545 |
| NPI Number | 1508153297 |
|---|---|
| Provider Enumeration Date | 07/01/2011 |
| Last Update Date | 05/20/2014 |
| Medicare PECOS PAC ID | 1153599857 |
|---|---|
| Medicare Enrollment ID | O20110725000505 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508153297 | NPI | - | NPPES |
| A83896 | Medicaid | CA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | A83896 (California) | Primary |
| 207RA0000X | Internal Medicine - Adolescent Medicine | (* (Not Available)) | Secondary |
| Provider Name | Maria Geraldina Fuentes |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1811070261 PECOS PAC ID: 4183692536 Enrollment ID: I20040922001176 |
| Provider Name | Maricel V Delacruz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1700314978 PECOS PAC ID: 8729352943 Enrollment ID: I20170926003056 |
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