Provider Demographics
NPI:1902601859
Name:FUENTES, RICHARD M JR
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:M
Last Name:FUENTES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6950 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2316
Mailing Address - Country:US
Mailing Address - Phone:916-840-1954
Mailing Address - Fax:
Practice Address - Street 1:6950 65TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95823-2316
Practice Address - Country:US
Practice Address - Phone:916-393-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-14
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker