Individual
SAMANTHA FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPT
Contact information
Practice address
679 S NEW HAMPSHIRE AVE FL 4, LOS ANGELES, CA 90005-1355
(213) 639-2500
Mailing address
150 S BEACH BLVD APT 285, LA HABRA, CA 90631-5174
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
40404
CA
Other
Enumeration date
06/04/2018
Last updated
06/04/2018
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