MEDICARE: ANA FUENTEVILLA MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	T9687	TX
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	18893	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679554430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANA FUENTEVILLA MD

Provider Business Mailing Address
First Line	:	211 E 7TH ST STE 700
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-3218
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2500 W WILLIAM CANNON DR STE 205
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5288
Country	:	US
Telephone Number	:	512-548-0465
Fax Number	:	737-707-3908

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	12/08/2022

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