Provider Demographics
NPI:1376220152
Name:FUENTES, DAVID GREGORIO SR (CPL)
Entity Type:Individual
Prefix:PROF
First Name:DAVID
Middle Name:GREGORIO
Last Name:FUENTES
Suffix:SR
Gender:M
Credentials:CPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. WONDERVILLE
Mailing Address - Street 2:CALLE 6 URANO
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976
Mailing Address - Country:US
Mailing Address - Phone:787-321-7929
Mailing Address - Fax:
Practice Address - Street 1:URB. WONDERVILLE
Practice Address - Street 2:CALLE 6 URANO
Practice Address - City:TRUJILLO ALTO
Practice Address - State:PR
Practice Address - Zip Code:00976
Practice Address - Country:US
Practice Address - Phone:787-321-7929
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4581101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional