Healthcare Provider Details

I. General information

NPI: 1649117110
Provider Name (Legal Business Name): LAURA FUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1070 W 56TH ST
HIALEAH FL
33012-2343
US

IV. Provider business mailing address

1070 W 56TH ST
HIALEAH FL
33012-2343
US

V. Phone/Fax

Practice location:
  • Phone: 786-606-7474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN9558627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: