Provider Demographics
NPI:1487403788
Name:FUENTES, JORDAN YVETTE
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:YVETTE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 N 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-1199
Mailing Address - Country:US
Mailing Address - Phone:575-748-3333
Mailing Address - Fax:
Practice Address - Street 1:1410 N 8TH ST STE B
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3217
Practice Address - Country:US
Practice Address - Phone:575-736-8520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered