Provider Demographics
NPI:1285770941
Name:FUENTES-WEST, MARYSOL (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:MARYSOL
Middle Name:
Last Name:FUENTES-WEST
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3940 7TH AVE UNIT 215
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3288
Mailing Address - Country:US
Mailing Address - Phone:619-422-7216
Mailing Address - Fax:619-426-1906
Practice Address - Street 1:815 3RD AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911
Practice Address - Country:US
Practice Address - Phone:619-422-7216
Practice Address - Fax:619-426-1906
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39962106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist