Provider Demographics
NPI:1487905659
Name:CYNTHIA FUENTES LSA, LLC
Entity type:Organization
Organization Name:CYNTHIA FUENTES LSA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED SURGICAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:LSA
Authorized Official - Phone:469-231-5309
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75168-0156
Mailing Address - Country:US
Mailing Address - Phone:469-231-5309
Mailing Address - Fax:972-913-0544
Practice Address - Street 1:10015 HERITAGE PL
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75217-7771
Practice Address - Country:US
Practice Address - Phone:469-231-5309
Practice Address - Fax:972-913-0544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXSA00072246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty