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NPI Code Detail

MEDICARE: ALIUSKA ALBA FUENTES

MEDICARE: ALIUSKA ALBA FUENTES
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1902395684
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALIUSKA ALBA FUENTES
Provider Business Mailing Address
First Line : 300 INTERNATIONAL PKWY STE 299
Second Line :
City : LAKE MARY
State : FL
Zip : 32746-5035
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4085 HANCOCK BRIDGE PKWY STE 101
Second Line :
City : NORTH FORT MYERS
State : FL
Zip : 33903-7220
Country : US
Telephone Number : 239-677-3767
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2018
Last Update Date : 03/06/2024

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Directions to “ ALIUSKA ALBA FUENTES ” Practice Location

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