Provider Demographics
NPI:1285476564
Name:FUENTES HART, FIDELINA ESTHER (PNP)
Entity type:Individual
Prefix:
First Name:FIDELINA
Middle Name:ESTHER
Last Name:FUENTES HART
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:FIDELINA
Other - Middle Name:E
Other - Last Name:ESCOBAR FUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FIDELINA E HART
Mailing Address - Street 1:23600 TELO AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4036
Mailing Address - Country:US
Mailing Address - Phone:310-833-1334
Mailing Address - Fax:
Practice Address - Street 1:23600 TELO AVE STE 130
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4036
Practice Address - Country:US
Practice Address - Phone:108-331-3343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-10
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026119363L00000X
CA95055553163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner