MEDICARE: JENNIFER MARIE FUENTES PHARM, D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P2201X	Ambulatory Care Pharmacist	5348	PR

General Provider Information

NPI Number	:	1033447768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER MARIE FUENTES PHARM, D.

Provider Business Mailing Address
First Line	:	1612 CALLE GUADIANA
Second Line	:	URB. EL CEREZAL
City	:	SAN JUAN
State	:	PR
Zip	:	00926-3012
Country	:	US
Telephone Number	:	787-546-6533
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 CALLE GUIADIANA
Second Line	:	URB EL CEREZAL
City	:	SAN JUAN
State	:	PR
Zip	:	00926-2942
Country	:	US
Telephone Number	:	787-546-6533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2009
Last Update Date	:	03/11/2017

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