=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841015229
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NYDIA FUENTES LOPEZ
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/20/2024
-----------------------------------------------------
Last Update Date | 11/20/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | CALLE BULBUL-EK MZ OS LT 12, GUERRA DE CASTAS
-----------------------------------------------------
City | TULUM
-----------------------------------------------------
State | QUINTANA ROO
-----------------------------------------------------
Zip | 77760
-----------------------------------------------------
Country | MX
-----------------------------------------------------
Telephone | 987-873-8462
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 11597
-----------------------------------------------------
City | FORT LAUDERDALE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33339-1597
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR
-----------------------------------------------------
Name | WILLIAM ALBERTO PARRA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 987-873-8462
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------