Individual
MR. EDMAN FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
900 GREENLEY RD, SUITE 914, SONORA, CA 95370-5287
(925) 469-6274
(925) 924-1769
Mailing address
5725 W LAS POSITAS BLVD, SUITE 200, PLEASANTON, CA 94588-4054
(925) 469-6274
(925) 924-1769
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
PA.008727
CO
363AS0400X
Surgical Physician Assistant
Primary
PA51630
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
291613400
—
FL
01
—
PA51630
MEDICAL LICENSE
CA
01
—
PA9102297
MEDICAL LICENSE
FL
Enumeration date
01/30/2006
Last updated
01/21/2025
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