Individual
STEPHEN MARK PUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5850 S MAIN ST, ROOM 1127, LOS ANGELES, CA 90003-1215
(323) 846-4219
(323) 238-0210
Mailing address
8902 WOODMAN AVE, ARLETA, CA 91331-6401
(818) 830-7033
(818) 830-7280
Taxonomy
Speciality
Code
Description
License number
State
207RI0200X
Infectious Disease Physician
Primary
G63475
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
952662606
TAX ID EPDB GROUP
CA
05
—
FHC 11866 F
—
CA
05
—
FHC70468F
—
CA
05
—
FHC70769F
—
CA
01
—
G063475
MEDICAL LICENSE
CA
Enumeration date
01/26/2007
Last updated
03/24/2010
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