MR. EDMAN FUENTES PAC NPI 1013988955

NPI Information

NPI: 1013988955
Provider Name: MR. EDMAN FUENTES, PAC
Classification: Physician Assistant - 363AS0400X
Entity Type: Individual

Specialization: Surgical

PECOS Registration: Yes

Address:
900 GREENLEY RD
SUITE 914
SONORA, CA
ZIP 95370
Phone: (925) 469-6274
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MR. Edman Fuentes, PAC is a surgical physician assistant in Sonora, CA with 22 years of experience. MR. Edman Fuentes, PAC NPI is 1013988955. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

900 GREENLEY RD
SUITE 914
SONORA, CA
ZIP 95370-287
Phone: (925) 469-6274
Fax: (925) 924-1769

The NPI 1013988955 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 1/30/2006 and was last updated on 6/10/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363AS0400X	Physician Assistant	Surgical	PA51630	CALIFORNIA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	P78417	MEDICARE UPIN
2	PA51630	OTHER	CALIFORNIA	MEDICAL LICENSE
3	PA9102297	OTHER	FLORIDA	MEDICAL LICENSE
4	291613400	MEDICAID	FLORIDA
5	U0141Z	MEDICARE PIN	FLORIDA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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