Healthcare Provider Details

I. General information

NPI: 1841015229
Provider Name (Legal Business Name): NYDIA FUENTES LOPEZ
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE BULBUL-EK MZ OS LT 12, GUERRA DE CASTAS
TULUM QUINTANA ROO
77760
MX

IV. Provider business mailing address

PO BOX 11597
FORT LAUDERDALE FL
33339-1597
US

V. Phone/Fax

Practice location:
  • Phone: 987-873-8462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ALBERTO PARRA
Title or Position: DIRECTOR
Credential:
Phone: 987-873-8462