Provider Demographics
NPI:1053025825
Name:FUENTES GONZALEZ, YESEIDI L
Entity type:Individual
Prefix:
First Name:YESEIDI
Middle Name:L
Last Name:FUENTES GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 OCASO DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-4252
Mailing Address - Country:US
Mailing Address - Phone:939-249-2149
Mailing Address - Fax:
Practice Address - Street 1:1504 OCASO DR
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-4252
Practice Address - Country:US
Practice Address - Phone:939-249-2149
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-06
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP6935235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist