Provider Demographics
NPI:1083716807
Name:FUENTES, LUZ STELLA (OT)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:STELLA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10265 SW 143RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-7071
Mailing Address - Country:US
Mailing Address - Phone:786-525-1184
Mailing Address - Fax:305-378-6736
Practice Address - Street 1:10265 SW 143RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-7071
Practice Address - Country:US
Practice Address - Phone:786-525-1184
Practice Address - Fax:305-378-6736
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT 9863225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886889100Medicaid