Provider Demographics
NPI:1942269972
Name:FUENTES, JULIAN ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ROBERT
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:JULIAN
Other - Middle Name:ROBERTO
Other - Last Name:FUENTES
Other - Suffix:III
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 991868
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099-1868
Mailing Address - Country:US
Mailing Address - Phone:530-339-0025
Mailing Address - Fax:
Practice Address - Street 1:3330 CHURN CREEK RD STE D4
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-2532
Practice Address - Country:US
Practice Address - Phone:530-247-4211
Practice Address - Fax:530-247-4241
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG45631207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50122Medicare UPIN