Provider Demographics
NPI:1467536862
Name:DE LA FUENTE, RACHELLE BEATRICE (MD)
Entity Type:Individual
Prefix:
First Name:RACHELLE
Middle Name:BEATRICE
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1226 ESTATES LN
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11360-1140
Mailing Address - Country:US
Mailing Address - Phone:718-428-8920
Mailing Address - Fax:
Practice Address - Street 1:82-68, 164TH STREET
Practice Address - Street 2:QUEENS HOSPITAL CENTER
Practice Address - City:QUEENS
Practice Address - State:NY
Practice Address - Zip Code:11432
Practice Address - Country:US
Practice Address - Phone:718-883-3000
Practice Address - Fax:718-883-6124
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243246207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY177SE79231Medicare ID - Type Unspecified