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Individual

MR. MANRIQUE FUENTES JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
RD, LD

Contact information

Practice address
2525 N VETERANS BLVD, EAGLE PASS, TX 78852-3302
(830) 773-6963
(830) 757-5746
Mailing address
3406 BOB ROGERS DR STE 120, EAGLE PASS, TX 78852-5942
(830) 757-4900
(830) 757-4982

Taxonomy

Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
DT81855
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DT81855
TX STATE BOARD OF EXAMINERS OF DIETITIANS
TX
Enumeration date
11/01/2011
Last updated
11/08/2018
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