MEDICARE: DR. JOHANNA C FUENTES-VALDES M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	8471315-1205	UT
2	207R00000X	Internal Medicine Physician	C137378	CA
3	207R00000X	Internal Medicine Physician	ME153583	FL

General Provider Information

NPI Number	:	1184641987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHANNA C FUENTES-VALDES M.D.

Provider Business Mailing Address
First Line	:	2748 WINDGUARD CIR STE 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7364
Country	:	US
Telephone Number	:	813-461-4428
Fax Number	:	813-291-7397

Provider Business Practice Location Address
First Line	:	2748 WINDGUARD CIR STE 102
Second Line	:
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-7364
Country	:	US
Telephone Number	:	813-461-4428
Fax Number	:	813-291-7397

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2006
Last Update Date	:	07/29/2024

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