Provider Demographics
NPI:1174135958
Name:DE LA FUENTE, BRYAN
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:DE LA FUENTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44423 HANSTEAD AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-3224
Mailing Address - Country:US
Mailing Address - Phone:310-791-3064
Mailing Address - Fax:
Practice Address - Street 1:44423 HANSTEAD AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-3224
Practice Address - Country:US
Practice Address - Phone:310-791-3064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist