ANGEL FUENTES (NPI# 1508145889) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508145889 |
| Entity Type | Individual |
| Full Name | ANGEL FUENTES |
| Credential | LMFT |
| Practice Address |
614 Tully Rd San Jose CA 95111-1048 |
| Mailing Address |
614 Tully Rd San Jose CA 95111 |
| Practice Telephone | 4084941536 |
| Mailing Telephone | (408) 494-1536 |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2018-03-17 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 101YA0400X |
Counselor Specialization: Addiction (Substance Use Disorder) |
Behavioral Health & Social Service Providers | ||
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
81064 | CA | Behavioral Health & Social Service Providers |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 90 Great Oaks Blvd, 108, San Jose, CA 951191314 | 4082810708 | 4082812658 |
| Street Address |
614 TULLY RD |
| City | SAN JOSE |
| State | CA |
| Zip Code | 95111-1048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699843060 | Minh Chau Duong | Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2006-12-01 |
| 1629630421 | Sonia Clemente | Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-07-01 |
| 1376109629 | Gardner Family Health Network Inc | Community/Behavioral Health | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-05-13 |
| 1316406481 | Ngoc Nguyen Hong Pham | Social Worker | 614 Tully Rd, San Jose, CA 95111-1048 | 2019-03-18 |
| 1386114437 | Eloisa Ivette Rodriguez | Social Worker | 614 Tully Rd, San Jose, CA 95111-1048 | 2018-12-03 |
| 1275016669 | Carolina Garcia | Rehabilitation Counselor | 614 Tully Rd, San Jose, CA 95111-1048 | 2018-09-11 |
| 1326572959 | Mar Joseph Odias | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-04-20 |
| 1770021206 | Ryan Pagala | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
| 1134667652 | Veronica Pham | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
| 1952849481 | Michael Borromeo | Registered Nurse | 614 Tully Rd, San Jose, CA 95111-1048 | 2017-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134667413 | Aldo Hernandez | Community Health Worker | 488 Skyway Dr, San Jose, CA 95111 | 2017-02-07 |
| 1518217017 | Jean Jennifer J Soliven | Registered Nurse | 614 Tully Rd., San Jose, CA 95111 | 2012-09-12 |
| 1679894604 | Julie Chi | Counselor | 581 Coyote Road, San Jose, CA 95111 | 2010-06-14 |
| 1720278179 | Mv Transportation | Non-emergency Medical Transport (VAN) | 555 Tully Road, Mv Transportation, San Jose, CA 95111 | 2007-07-31 |
| 1437355948 | Anthony Cozzolino | Psychiatry & Neurology | 614 Tully Road, Narvaez Mental Health, San Jose, CA 95111 | 2007-06-22 |
| 1750403515 | Karen Pham | Dentist | 4074 Monterey Road, San Jose, CA 95111 | 2007-04-04 |
| 1376697847 | Mai Anh Le | Dentist | 60 Senter Rd, San Jose, CA 95111 | 2007-01-22 |
| 1649335852 | Bui and Enriquez Dental Corporation | Dentist | 485 Lewis Rd, Suite A, San Jose, CA 95111 | 2006-12-27 |
| 1619031903 | Huyen Thu Nguyen | Pharmacist | 796 Apple Terrace, San Jose, CA 95111 | 2006-12-20 |
| 1285720342 | Lily Khanh-linh Thi Nguyen | Obstetrics & Gynecology | 500 W Tully Rd, Ob/gyn Clinic, San Jose, CA 95111 | 2006-10-05 |
| Find all providers in zip 95111 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912507021 | Lucid Lane Providers, P.C. | Counselor | 3251 Place Du Jardin, Optional, San Jose, CA 95148-9514 | 2020-10-28 |
| 1700491800 | Sean Garcia | Counselor | 2959 Carrington Ct, San Jose, CA 95125-4882 | 2020-09-15 |
| 1659985240 | Meng Chang Licensed Marriage and Family Therapist | Counselor | 1174 Lincoln Ave Ste 8, San Jose, CA 95125-3029 | 2020-09-02 |
| 1932721115 | Ellen C Gagne | Counselor | 290 N 2nd St Ste 202, San Jose, CA 95112-4143 | 2020-05-11 |
| 1215566773 | Michelle L. Powers | Counselor | 2 N Market St Ste 500, San Jose, CA 95113-1211 | 2020-04-06 |
| 1841823069 | Ana Gabriella Marquez | Counselor | 298 Bernal Rd # A, San Jose, CA 95119-1809 | 2020-02-17 |
| 1063044741 | Alyssa N Thompson | Counselor | 423 Los Arboles St, San Jose, CA 95111-2344 | 2020-02-10 |
| 1336770288 | Genevieve Altwer | Counselor | 3150 Almaden Expy Ste 223, San Jose, CA 95118-1253 | 2020-01-29 |
| 1477183705 | Benjamin C Jensen | Counselor | 1366 Petal Way, San Jose, CA 95129-4722 | 2020-01-26 |
| 1659910529 | Fred Finch Youth Center | Counselor | 2625 Zanker Rd Ste 122, San Jose, CA 95134-2130 | 2019-12-24 |
| Find all providers in SAN JOSE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.