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General NPI Number Information
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NPI Number | 1578104006
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Entity Type | Individual
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Provider Name | DANIELA AMAYA FUENMAYOR
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Gender | Female
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Dates
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Enumeration Date | 10/07/2019
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Last Update Date | 05/13/2021
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Provider Practice Location Address
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Address Line | 30 THORPE LN
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City | SPRING
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State | TX
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Zip | 77389-1629
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Country | US
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Telephone | 787-600-2415
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Fax |
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Provider Business Mailing Address
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Address Line | 11011 W NORTH AVE APT 367
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City | WAUWATOSA
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State | WI
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Zip | 53226-2271
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Country | US
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Telephone | 787-600-2415
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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 | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 004-R
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 35864
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License Number State | TX
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