Healthcare Provider Details

I. General information

NPI: 1881727014
Provider Name (Legal Business Name): DELFIN J FUENTES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

483 N SEMORAN BLVD STE 206
WINTER PARK FL
32792-3800
US

IV. Provider business mailing address

601 S HARBOUR ISLAND BLVD STE 200
TAMPA FL
33602-5925
US

V. Phone/Fax

Practice location:
  • Phone: 407-678-2400
  • Fax: 407-678-4926
Mailing address:
  • Phone: 800-480-5243
  • Fax: 800-928-7449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME99867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: