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General NPI Number Information
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NPI Number | 1003331745
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Entity Type | Individual
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Provider Name | MARIELA FUENTES
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Gender | Female
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Dates
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Enumeration Date | 08/03/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 8415 SW 24TH ST STE 205
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City | MIAMI
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State | FL
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Zip | 33155-2305
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Country | US
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Telephone | 305-262-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 13768 SW 157 ST
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City | MIAMI
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State | FL
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Zip | 33177
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Country | US
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Telephone | 305-300-8705
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | SI2424
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License Number State | FL
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