Healthcare Provider Details

I. General information

NPI: 1225966005
Provider Name (Legal Business Name): MARTIN FUENTES GONZALEZ RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 COLUMBIA ST
ORLANDO FL
32806-1115
US

IV. Provider business mailing address

4519 APPLEBY CT
ORLANDO FL
32817-3148
US

V. Phone/Fax

Practice location:
  • Phone: 321-842-1000
  • Fax:
Mailing address:
  • Phone: 407-283-4854
  • Fax: 407-283-4854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9653679
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: