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General NPI Number Information
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NPI Number | 1508583741
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Entity Type | Individual
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Provider Name | BRANDON FUENTES
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Gender | Male
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Dates
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Enumeration Date | 10/27/2022
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Last Update Date | 10/27/2022
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Provider Practice Location Address
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Address Line | 1285 CREEKSIDE BLVD E
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City | NAPLES
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State | FL
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Zip | 34109-0590
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Country | US
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Telephone | 803-269-2798
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Fax |
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Provider Business Mailing Address
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Address Line | 9033 MADRID CIR
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City | NAPLES
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State | FL
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Zip | 34104-6228
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Country | US
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Telephone | 803-269-2798
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | PTA28862
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License Number State | FL
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