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General NPI Number Information
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NPI Number | 1134535198
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Entity Type | Organization
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Legal Business Name | ILEANA FUENTES MD, PA
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Dates
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Enumeration Date | 07/10/2014
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Last Update Date | 07/10/2014
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Provider Practice Location Address
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Address Line | 4343 W FLAGLER ST STE 210
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City | CORAL GABLES
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State | FL
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Zip | 33134-1586
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Country | US
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Telephone | 305-588-4290
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Fax |
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Provider Business Mailing Address
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Address Line | 3150 SW 108TH AVE
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City | MIAMI
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State | FL
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Zip | 33165-2450
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Country | US
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Telephone | 305-588-4290
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ILEANA FUENTES
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Credential | M.D.
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Telephone | 305-588-4290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | ME75683
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License Number State | FL
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