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General NPI Number Information
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NPI Number | 1356797708
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Entity Type | Individual
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Provider Name | MARLENE FUENTES CASANAS
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Gender | Female
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 1033 SW 167 AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027
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Country | US
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Telephone | 786-280-5702
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Fax |
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Provider Business Mailing Address
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Address Line | 1033 SW 167TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33027-1423
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Country | US
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Telephone | 786-280-5702
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 16-241
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License Number State | FL
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