Organization
MORNING STAR FAMILY MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDWIN L FUENTES D.O. (OWNER/PHYSICIAN)
(909) 931-0446
Entity
Organization
Contact information
Practice address
99 N SAN ANTONIO AVE, SUITE 330, UPLAND, CA 91786-4575
(909) 931-0446
Mailing address
99 N SAN ANTONIO AVE, SUITE 330, UPLAND, CA 91786-4575
(909) 931-0446
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
20A12006
CA
Other
Enumeration date
11/30/2015
Last updated
11/30/2015
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