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General NPI Number Information
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NPI Number | 1164050001
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Entity Type | Individual
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Provider Name | RUSDANY COLLADO FUENTES MD
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Gender | Male
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Dates
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Enumeration Date | 03/27/2020
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Last Update Date | 01/17/2025
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Provider Practice Location Address
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Address Line | 10621 N KENDALL DR STE 200
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City | MIAMI
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State | FL
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Zip | 33176-1530
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Country | US
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Telephone | 786-334-2494
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Fax | 786-221-2883
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Provider Business Mailing Address
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Address Line | 13783 SW 66TH ST APT A219
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City | MIAMI
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State | FL
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Zip | 33183-2200
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Country | US
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Telephone | 305-502-3553
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME159106
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | ME159106
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License Number State | FL
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