Healthcare Provider Details

I. General information

NPI: 1144759515
Provider Name (Legal Business Name): MONIQUE LA FUENTE OCULARIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 02/10/2025
Certification Date: 02/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 NW 9TH ST # 102
OKLAHOMA CITY OK
73102-2619
US

IV. Provider business mailing address

3215 SE PINTO ST
PORT SAINT LUCIE FL
34984-6506
US

V. Phone/Fax

Practice location:
  • Phone: 405-774-0118
  • Fax:
Mailing address:
  • Phone: 405-774-0118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: