Healthcare Provider Details

I. General information

NPI: 1487839700
Provider Name (Legal Business Name): MARIA DE LOS ANGELES PUENTES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2008
Last Update Date: 01/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16919 N BAY RD APT 918
SUNNY ISLES BEACH FL
33160-4220
US

IV. Provider business mailing address

16919 N BAY RD APT 918
SUNNY ISLES BEACH FL
33160-4220
US

V. Phone/Fax

Practice location:
  • Phone: 786-333-7402
  • Fax: 305-945-5134
Mailing address:
  • Phone: 786-333-7402
  • Fax: 305-945-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number6931341 96
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: