Fuentes, Isabella

Fuentes, Isabella is an individual health care provider with primary practice located at 88 S Main St , Glen Carbon IL 62034-1415. She recently has only one registered license in Behavioral Health & Social Service Providers / Mental Health, which is considered as her primary health care specialty. Fuentes, Isabella can be contacted via phone (618) 288-8085.

Contact Information

Primary practice address
88 S Main St Glen Carbon IL 62034-1415
Phone: (618) 288-8085
Fax: (618) 288-8959
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X

Profile Details

NPI number 1770357824
LBN Legal business name Fuentes, Isabella
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 9th, 2023
Last updated Nov 9th, 2023 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1770357824 NPPES
Illinois MEDICAID 4A00-IPI-032

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