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General NPI Number Information
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NPI Number | 1598829137
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Entity Type | Organization
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Legal Business Name | ERNESTO FUENTES MD PA
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 11/22/2013
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Provider Practice Location Address
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Address Line | 601 N FLAMINGO RD SUITE 400
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-1015
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Country | US
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Telephone | 954-687-9745
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Fax | 954-666-0668
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Provider Business Mailing Address
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Address Line | 2114 N FLAMINGO RD STE 306
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City | PEMBROKE PINES
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State | FL
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Zip | 33028-3501
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Country | US
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Telephone | 954-687-9745
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Fax | 954-666-0668
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERNESTO FUENTES
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Credential | MD PA
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Telephone | 954-687-9745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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