Individual
ROLAND FUENTES
Active
Individual
ROLAND FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA10002237
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0039594
LABOR AND INDUSTRIES
WA
01
—
2571FU
BLUE SHIELD #
WA
05
—
8380453
—
WA
01
—
US2541825
AETNA SPECIALIST PIN
WA
Enumeration date
02/01/2007
Last updated
04/07/2008
Update your record
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