Individual
MS. CAROL SUE FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS PA-C
Contact information
Practice address
1288 MORRO ST, SAN LUIS OBISPO, CA 93401-6301
(805) 543-1233
Mailing address
1288 MORRO ST, SAN LUIS OBISPO, CA 93401-6302
(805) 543-1233
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA15472
CA
Other
Enumeration date
06/09/2006
Last updated
07/08/2007
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