Active NPI
Cynthia Fuentes, LSA, CFA, CST
- Surgical Physician Assistant
- Dallas, TX
National Provider Identifier
1396789707
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgical Physician Assistant
- License
- SA00072
- Practice address
- 10015 Heritage PL
Dallas, TX 75217-7771 - Phone
- (469) 231-5309
- Fax
- (972) 913-0544
- NPI assigned
- Jun 15, 2006
- Last updated
- Oct 21, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgical Physician Assistant | 363AS0400X | SA00072 | TX | Primary |
| Surgical Technologist | 246ZS0410X | SA00072 | TX |
Addresses
Primary practice location
10015 Heritage PL
Dallas, TX 75217-7771
Mailing address
PO Box 156
Waxahachie, TX 75168-0156
Phone (469) 231-5309
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 89N932 | Other | TX | BLUE CROSS BLUE SHEILD |
| 83819 | Other | TX | NCST FIRST ASST |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA00072 | TX | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cynthia Fuentes Lsa, LLC | Surgical Technologist | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Surgical Technologist
- Dallas, TX
- NPI 1487905659
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1508544000000",
"number": "1396789707",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 156",
"city": "WAXAHACHIE",
"state": "TX",
"postal_code": "751680156",
"telephone_number": "469-231-5309",
"fax_number": "972-913-0544"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10015 HERITAGE PL",
"city": "DALLAS",
"state": "TX",
"postal_code": "752177771",
"telephone_number": "469-231-5309",
"fax_number": "972-913-0544"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "CYNTHIA",
"name_prefix": "Ms.",
"credential": "LSA, CFA, CST",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-06-15",
"last_updated": "2017-10-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AS0400X",
"taxonomy_group": "",
"desc": "Physician Assistant, Surgical",
"state": "TX",
"license": "SA00072",
"primary": true
},
{
"code": "246ZS0410X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Other, Surgical Technologist",
"state": "TX",
"license": "SA00072",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHEILD",
"identifier": "89N932",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCST FIRST ASST",
"identifier": "83819",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 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.