| Doctor Name: | MR. EDMAN FUENTES |
| NPI Number: | 1013988955 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PAC |
| License Number: | PA51630 |
| Business Practice Address: | 900 Greenley Rd Suite 914 Sonora, CA - 953705287 |
| Business Phone Number: | 9254696274 |
| Business Fax Number: | 9259241769 |
| Mailing Address: | 5725 W Las Positas Blvd, Suite 200 PLEASANTON |
| State: | CA |
| Postal Code: | 945884054 |
| Phone Number: | 9254696274 |
| Fax Number: | 9259241769 |
| NPI Enumeration Date: | 01/30/2006 |
| NPI Last Update Date: | 06/10/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | PA51630 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |