Provider Demographics
NPI:1043742497
Name:FUENTES, MARLEN VANESSA
Entity Type:Individual
Prefix:
First Name:MARLEN
Middle Name:VANESSA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 BRICKELL BAY DR
Mailing Address - Street 2:APT 603
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33131-2983
Mailing Address - Country:US
Mailing Address - Phone:786-486-2030
Mailing Address - Fax:
Practice Address - Street 1:306 ALCAZAR AVE
Practice Address - Street 2:SUITE 303-C
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4318
Practice Address - Country:US
Practice Address - Phone:786-558-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker