Active NPI
Cynthia De Leon Fuentes
- Marriage & Family Therapist
- Los Angeles, CA
National Provider Identifier
1518277656
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 69708
- Practice address
- 12420 Venice Blvd Ste 200
Los Angeles, CA 90066-3841 - Phone
- (310) 751-1200
- Fax
- (310) 398-0312
- NPI assigned
- Oct 7, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | |||
| Marriage & Family Therapist | 106H00000X | 69708 | CA | Primary |
Addresses
Primary practice location
12420 Venice Blvd Ste 200
Los Angeles, CA 90066-3841
Mailing address
4760 Sepulveda Blvd
Culver City, CA 90230-4820
Phone (310) 390-6612
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 |
|---|---|---|---|
| 69708 | CA | MD | Massage Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1286409600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442534400000",
"number": "1518277656",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4760 SEPULVEDA BLVD",
"city": "CULVER CITY",
"state": "CA",
"postal_code": "902304820",
"telephone_number": "310-390-6612",
"fax_number": "310-398-5690"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12420 VENICE BLVD STE 200",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900663841",
"telephone_number": "310-751-1200",
"fax_number": "310-398-0312"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DE LEON FUENTES",
"first_name": "CYNTHIA",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-10-07",
"last_updated": "2015-09-18",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "69708",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.