Individual
ROLAND FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
1100 9TH AVE, SEATTLE, WA 98101-2756
(206) 223-6600
Mailing address
1100 OLIVE WAY MSC M4-PA, SEATTLE, WA 98101-1873
(206) 515-5811
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
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