Provider Demographics
NPI:1235813270
Name:FUENTES, RALFRED G
Entity Type:Individual
Prefix:
First Name:RALFRED
Middle Name:G
Last Name:FUENTES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:593 TALISI LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34771-9165
Mailing Address - Country:US
Mailing Address - Phone:786-237-6082
Mailing Address - Fax:
Practice Address - Street 1:593 TALISI LOOP
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34771-9165
Practice Address - Country:US
Practice Address - Phone:786-237-6082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF532727890610343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)