Provider Demographics
NPI:1992490544
Name:PUENTE MORENO, JOSE GONZALO (MD)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:GONZALO
Last Name:PUENTE MORENO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2233
Mailing Address - Country:US
Mailing Address - Phone:559-686-9097
Mailing Address - Fax:559-366-7060
Practice Address - Street 1:1101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2231
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-366-7060
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAP22207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine