Derrainnya Fuentes, PHD

Primary specialty

Prevention ProfessionalTaxonomy code 405300000X

License

4439413 Issued in AZ

Practice address

19935 E Chandler Heights Rd
Queen Creek, AZ 85142-9350

Phone

(602) 670-2115

NPI assigned

Feb 20, 2017

Last updated

Feb 20, 2017By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• American Leadership Academy

  • Local Education Agency (LEA)
  • Queen Creek, AZ
  • NPI 1699186759
  NPD (past)
• American Leadership Academy, Inc.

  • Bus
  • Queen Creek, AZ
  • NPI 1750813192
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1487548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1487548800000",
    "number": "1033658323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19935 E CHANDLER HEIGHTS ROAD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "85142",
            "telephone_number": "602-670-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19935 E CHANDLER HEIGHTS RD",
            "city": "QUEEN CREEK",
            "state": "AZ",
            "postal_code": "851429350",
            "telephone_number": "602-670-2115"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "DERRAINNYA",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-02-20",
        "last_updated": "2017-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "AZ",
            "license": "4439413",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prevention Professional in Queen Creek, AZ
• Providers in Queen Creek, AZ by specialty
• Prevention Professional in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.