Provider Demographics
NPI:1346213949
Name:FUENTES FIGUEROA, HERNAN G (MD)
Entity Type:Individual
Prefix:
First Name:HERNAN
Middle Name:G
Last Name:FUENTES FIGUEROA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2850 SW 114TH TER APT 512
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18669 TAMIAMI TR
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-7388
Practice Address - Country:US
Practice Address - Phone:941-423-5035
Practice Address - Fax:941-423-5034
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14096207V00000X
TXN8187207V00000X
FLME133886207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR22638Medicare ID - Type UnspecifiedPROVIDER NUMBER
PRI33171Medicare UPIN