Healthcare Provider Details

I. General information

NPI: 1912726142
Provider Name (Legal Business Name): GABRIELA PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2024
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8257 SW 124TH ST
PINECREST FL
33156-5900
US

IV. Provider business mailing address

212 POINCIANA ISLAND DR
SUNNY ISLES BEACH FL
33160-4519
US

V. Phone/Fax

Practice location:
  • Phone: 786-487-6324
  • Fax:
Mailing address:
  • Phone: 786-487-6324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: