Individual
BERTHA A FUENTES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3550 CAMINO DEL RIO N STE 104, SAN DIEGO, CA 92108-1738
(928) 581-6478
Mailing address
181 E ORANGE AVE APT 3, CHULA VISTA, CA 91911-5436
(928) 581-6478
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
09/21/2022
Last updated
11/16/2022
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