Healthcare Provider Details

I. General information

NPI: 1700820024
Provider Name (Legal Business Name): LUIS FUENTES AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 SW 77TH AVE SUITE 101
MIAMI FL
33156-7988
US

IV. Provider business mailing address

9420 SW 77TH AVE SUITE 101
MIAMI FL
33156-7988
US

V. Phone/Fax

Practice location:
  • Phone: 305-412-0011
  • Fax: 305-412-3837
Mailing address:
  • Phone: 305-412-0011
  • Fax: 305-412-3837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP000791
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: