Healthcare Provider Details

I. General information

NPI: 1003630419
Provider Name (Legal Business Name): RUBIA FUENTES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73 MARKET ST
YONKERS NY
10710-7616
US

IV. Provider business mailing address

1345 AVENUE OF THE AMERICAS FL 8
NEW YORK NY
10105-0018
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8073
  • Fax:
Mailing address:
  • Phone: 908-588-3635
  • Fax: 908-934-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF353441-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: