Individual
MR. GAUDENCIO FUENTES CELESTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8674 134TH ST W, APPLE VALLEY, MN 55124-7234
(952) 452-2827
Mailing address
8674 134TH ST W, APPLE VALLEY, MN 55124-7234
(952) 452-2827
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
9275
MN
Other
Enumeration date
03/21/2016
Last updated
03/21/2016
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