Healthcare Provider Details

I. General information

NPI: 1992611446
Provider Name (Legal Business Name): MARCELA C FUENZALIDA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8850 NW 122ND ST
HIALEAH FL
33018-1748
US

IV. Provider business mailing address

11115 W OKEECHOBEE RD UNIT 129
HIALEAH FL
33018-4272
US

V. Phone/Fax

Practice location:
  • Phone: 305-351-7181
  • Fax:
Mailing address:
  • Phone: 786-759-6896
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number23740
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: