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General NPI Number Information
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NPI Number | 1962814558
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Entity Type | Individual
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Provider Name | PABLO ODELEY PUENTE FUMERO MD
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Gender | Male
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 04/09/2021
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Provider Practice Location Address
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Address Line | 1228 MILAN AVE
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City | CORAL GABLES
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State | FL
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Zip | 33134-3504
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Country | US
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Telephone | 703-501-8550
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Fax |
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Provider Business Mailing Address
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Address Line | AVE PABLO NERUDA 57 10-F
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City | MADRID
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State | MADRID
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Zip | 28018
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Country | ES
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | IMH14595
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | IMH14595
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License Number State | FL
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