Active NPI
Jesus Mendez Fuentes, PHYSICIAN ASSISTANT
- Physician Assistant
- Odessa, TX
National Provider Identifier
1891234969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA13121
- Practice address
- 2224 Alameda CT
Odessa, TX 79763-2273 - Phone
- (605) 393-5488
- NPI assigned
- Feb 22, 2017
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA13121 | CA | Primary |
Addresses
Primary practice location
2224 Alameda CT
Odessa, TX 79763-2273
Mailing address
2224 Alameda CT
Odessa, TX 79763-2273
Phone (605) 393-5488
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 |
|---|---|---|---|
| PA13121 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1487721600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1487721600000",
"number": "1891234969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2224 ALAMEDA CT",
"city": "ODESSA",
"state": "TX",
"postal_code": "797632273",
"telephone_number": "605-393-5488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2224 ALAMEDA CT",
"city": "ODESSA",
"state": "TX",
"postal_code": "797632273",
"telephone_number": "605-393-5488"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUENTES",
"first_name": "JESUS",
"middle_name": "MENDEZ",
"name_prefix": "Mr.",
"credential": "PHYSICIAN ASSISTANT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-22",
"last_updated": "2017-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA13121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Odessa, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 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.