Healthcare Provider Details

I. General information

NPI: 1174511265
Provider Name (Legal Business Name): KARLA FUENTES KIKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/18/2024
Certification Date: 07/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14041 NORTHWEST BLVD STE 1
CORPUS CHRISTI TX
78410-5138
US

IV. Provider business mailing address

14041 NORTHWEST BLVD STE 1
CORPUS CHRISTI TX
78410-5138
US

V. Phone/Fax

Practice location:
  • Phone: 361-767-9963
  • Fax: 361-767-1382
Mailing address:
  • Phone: 361-767-9963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberV1154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: