Sebastian Fuentes, PAC

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

PA 18064 Issued in CA

Practice address

2200 W 3Rd St Ste 300
Los Angeles, CA 90057-1936

Phone

(213) 639-2200

Fax

(213) 368-7739

NPI assigned

Apr 9, 2007

Last updated

Dec 2, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sebastian.fuentes.p1@direct.lakeside.nextgenshare.com

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.

• Golden State Emergency Physicians Inc

  • Emergency Medicine Physician
  • Los Angeles, CA
  • NPI 1770886558
  Medicare reassignment
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Baldwin Park, CA
  • NPI 1770515280
  Medicare reassignment
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Santa Clarita, CA
  • NPI 1316409410
  NPD
• Southern California Permanente Medical Group

  • Health Maintenance Organization
  • Pico Rivera, CA
  • NPI 1891287827
  NPD
• Garfield Emergency Medical Associates, Inc.

  • Emergency Medicine Physician
  • Monterey Park, CA
  • NPI 1386688125
  NPD (past)
• Lakeside Medical Associates, a Medical Group, Inc.

  dba Lakeside Community Healthcare Medical Group

  • Rheumatology Physician
  • Burbank, CA
  • NPI 1861499535
  NPD (past)
• Taro Yokoyama, M.D., a Professional Corporation

  dba Pacific Cardiothoracic Surgery Group

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Los Angeles, CA
  • NPI 1508912908
  NPD (past)

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638403200000",
    "number": "1194848457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 W 3RD ST STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571936",
            "telephone_number": "213-639-2200",
            "fax_number": "213-368-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 W 3RD ST STE 300",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900571936",
            "telephone_number": "213-639-2200",
            "fax_number": "213-368-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "SEBASTIAN",
        "name_prefix": "Mr.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-09",
        "last_updated": "2021-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "CA",
            "license": "PA 18064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "9333 Imperial Hwy",
            "city": "Downey",
            "state": "CA",
            "country_code": "US",
            "postal_code": "902422812",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Maria Fuentes
• Pamella Saldua Fuentes
• Raymond Fuentes
• Robert Steve Fuentes
• Samantha Fuentes, LPT
• Sonia Janet Fuentes, LCSW 71529
• Stephanie Fuentes
• Susan K Fuentes, RN,MSN
• Tiffany Fuentes
• Wendy Teresa Fuentes, LMFT

• Surgical Physician Assistant in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Surgical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.