Individual
ELIZABETH FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
121 DOWNEY AVE, MODESTO, CA 95354-1208
(209) 341-1824
Mailing address
1301 PIERCE ST, SAN FRANCISCO, CA 94115-4005
(415) 563-8200
(415) 563-9585
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
CA
171M00000X
Case Manager/Care Coordinator
—
—
372600000X
Adult Companion
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00
00
CA
Enumeration date
03/31/2016
Last updated
05/15/2025
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