Provider Demographics
NPI:1902530686
Name:FUERTE, ASHLEY GISELLE
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:GISELLE
Last Name:FUERTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:GISELLE
Other - Last Name:FUERTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:826 N SIESTA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91746-2019
Mailing Address - Country:US
Mailing Address - Phone:562-746-5294
Mailing Address - Fax:
Practice Address - Street 1:242 W FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-2147
Practice Address - Country:US
Practice Address - Phone:626-671-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY4190703103K00000X
106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst