Active NPI
Roger Fuentes
- Rehabilitation Practitioner
- Lodi, CA
National Provider Identifier
1619764644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Practitioner
- Practice address
- 408 E Pine St
Lodi, CA 95240-2923 - Phone
- (209) 369-1398
- NPI assigned
- Apr 23, 2025
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Rehabilitation Practitioner | 225400000X | Primary |
Addresses
Primary practice location
408 E Pine St
Lodi, CA 95240-2923
Mailing address
1824 St Mayeul Dr
Modesto, CA 95356-8402
Phone (352) 573-1936
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1745366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750118400000",
"number": "1619764644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1824 ST MAYEUL DR",
"city": "MODESTO",
"state": "CA",
"postal_code": "953568402",
"telephone_number": "352-573-1936"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "408 E PINE ST",
"city": "LODI",
"state": "CA",
"postal_code": "952402923",
"telephone_number": "209-369-1398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "ROGER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-04-23",
"last_updated": "2025-06-17",
"certification_date": "2025-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "225400000X",
"taxonomy_group": "",
"desc": "Rehabilitation Practitioner",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lodi, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.