Healthcare Provider Details

I. General information

NPI: 1275460990
Provider Name (Legal Business Name): JAMILETTE MARIE FUENTES POLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

JARDINES DEL CARIBE ST 45 2A11
PONCE PR
00728
US

IV. Provider business mailing address

JARDINES DEL CARIBE ST 45 2A11
PONCE PR
00728
US

V. Phone/Fax

Practice location:
  • Phone: 939-579-3652
  • Fax:
Mailing address:
  • Phone: 939-579-3652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number7539
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: