Individual
MS. CYNTHIA FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LSA, CFA, CST
Contact information
Practice address
10015 HERITAGE PL, DALLAS, TX 75217-7771
(469) 231-5309
(972) 913-0544
Mailing address
PO BOX 156, WAXAHACHIE, TX 75168-0156
(469) 231-5309
(972) 913-0544
Taxonomy
Speciality
Code
Description
License number
State
246ZS0410X
Surgical Technologist
SA00072
TX
363AS0400X
Surgical Physician Assistant
Primary
SA00072
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
83819
NCST FIRST ASST
TX
01
—
89N932
BLUE CROSS BLUE SHEILD
TX
Enumeration date
06/15/2006
Last updated
10/21/2017
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