Active NPI
Mayra Sanjuanita Fuentes, DDS
- Dentist
- Ediburg, TX
National Provider Identifier
1386026433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30964
- Practice address
- 206 W. Mahl St.
Ediburg, TX 78539 - Phone
- (956) 383-4400
- NPI assigned
- Jun 25, 2015
- Last updated
- Jun 25, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30964 | TX | Primary |
Addresses
Primary practice location
206 W. Mahl St.
Ediburg, TX 78539
Mailing address
206 W Mahl St
Edinburg, TX 78539-4331
Phone (956) 383-4400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150914002199 | TX | Order and Referring Only - Dentist | 7618284373 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30964 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435190400000",
"number": "1386026433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "206 W MAHL ST",
"city": "EDINBURG",
"state": "TX",
"postal_code": "785394331",
"telephone_number": "956-383-4400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "206 W. MAHL ST.",
"city": "EDIBURG",
"state": "TX",
"postal_code": "78539",
"telephone_number": "956-383-4400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "MAYRA",
"middle_name": "SANJUANITA",
"name_prefix": "Miss",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-25",
"last_updated": "2015-06-25",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "30964",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2015; 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.