Organization
SERGIO A. FUENZALIDA MD INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SERGIO A FUENZALIDA M.D. (OWNER)
(626) 576-7481
Entity
Organization
Contact information
Practice address
850 S ATLANTIC BLVD, SUITE 103, MONTEREY PARK, CA 91754-6703
(626) 576-7481
Mailing address
850 S ATLANTIC BLVD, SUITE 103, MONTEREY PARK, CA 91754-4730
(626) 576-7481
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
A25157
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A251570
—
CA
Enumeration date
07/27/2010
Last updated
08/03/2010
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