Individual provider Active NPI

Ashley Rina Fuentes, MSN, RN

  • Family Nurse Practitioner
  • San Diego, CA
National Provider Identifier
1609368000
Registry record updated Jul 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
95009172 Issued in CA
Practice address
6280 Jackson Dr
San Diego, CA 92119-3434
Phone
(619) 464-1607
NPI assigned
May 31, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 95009172 CA Primary

Addresses

Primary practice location

6280 Jackson Dr
San Diego, CA 92119-3434

Mailing address

2575 Elyssee St
San Diego, CA 92123-3438
Phone (808) 542-2642

Other practice location 1

2575 Elyssee St
San Diego, CA 92123-3438
Phone (808) 542-2642

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20191017002060 CA Practitioner - Nurse Practitioner 7416288790 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aram Harijan MD PCGroup PAC ID 5698001261, 9 clinicians

Practice addresses (Care Compare)

9500 El Granito Ave
La Mesa, CA 91941-4208
Phone (858) 717-5029

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

LicenseStateTypeSpecialty
95009172CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Centers of San Diego, Inc Current Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Apr 24, 2019 Accepting new patients
Family Health Centers of San Diego, Inc CurrentSince Apr 24, 2019 Accepting new patients
Cardiology of Southern California Past Accepting new patients

Locations

4725 Market St
San Diego, CA 92102
Phone (619) 515-2560

823 Gateway Center Way
San Diego, CA 92102
Phone (619) 515-2323

Organizations & group practices 5

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

NPI Registry JSON

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688342400000",
    "number": "1609368000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2575 ELYSSEE ST",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921233438",
            "telephone_number": "808-542-2642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6280 JACKSON DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921193434",
            "telephone_number": "619-464-1607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2575 Elyssee St",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921233438",
            "country_code": "US",
            "telephone_number": "808-542-2642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FUENTES",
        "first_name": "ASHLEY",
        "middle_name": "RINA",
        "credential": "MSN, RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-31",
        "last_updated": "2023-07-03",
        "certification_date": "2023-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95009172",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.