Healthcare Provider Details

I. General information

NPI: 1033447768
Provider Name (Legal Business Name): JENNIFER MARIE FUENTES PHARM, D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2009
Last Update Date: 03/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 CALLE GUIADIANA URB EL CEREZAL
SAN JUAN PR
00926-2942
US

IV. Provider business mailing address

1612 CALLE GUADIANA URB. EL CEREZAL
SAN JUAN PR
00926-3012
US

V. Phone/Fax

Practice location:
  • Phone: 787-546-6533
  • Fax:
Mailing address:
  • Phone: 787-546-6533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License Number5348
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: