Provider Demographics
NPI:1487724472
Name:FUENTES, VILMA (LICENSEDPSYCHOLOGIST)
Entity type:Individual
Prefix:
First Name:VILMA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LICENSEDPSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27874
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92809
Mailing Address - Country:US
Mailing Address - Phone:714-935-6135
Mailing Address - Fax:
Practice Address - Street 1:301 CITY DRIVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868
Practice Address - Country:US
Practice Address - Phone:714-935-6363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling