Provider Demographics
NPI:1497589519
Name:OREJEL, STEPHANIE FUENTES
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:FUENTES
Last Name:OREJEL
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 1:373 S 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2134
Mailing Address - Country:US
Mailing Address - Phone:928-975-2480
Mailing Address - Fax:
Practice Address - Street 1:5363 S TIERRA BONITA BLVD
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-7779
Practice Address - Country:US
Practice Address - Phone:928-975-2480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-30
Last Update Date:2024-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSERV-044144-07-20243747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider