Healthcare Provider Details

I. General information

NPI: 1073423539
Provider Name (Legal Business Name): TIANY FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

702 E 19TH ST
HIALEAH FL
33013-4134
US

IV. Provider business mailing address

702 E 19TH ST
HIALEAH FL
33013-4134
US

V. Phone/Fax

Practice location:
  • Phone: 786-899-3213
  • Fax:
Mailing address:
  • Phone: 786-899-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2848013
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: