Provider Demographics
NPI:1871748038
Name:FUENTEZ, DAWN DINEROS (OTR/L)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:DINEROS
Last Name:FUENTEZ
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3914 SPRINGFIELD CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94555-2253
Mailing Address - Country:US
Mailing Address - Phone:510-894-4913
Mailing Address - Fax:
Practice Address - Street 1:3914 SPRINGFIELD CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555-2253
Practice Address - Country:US
Practice Address - Phone:510-894-4913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-01
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12494225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist