Provider Demographics
NPI:1518466705
Name:PUENTES, MIGUEL A SR
Entity Type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:A
Last Name:PUENTES
Suffix:SR
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:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33970-0516
Mailing Address - Country:US
Mailing Address - Phone:239-288-9470
Mailing Address - Fax:
Practice Address - Street 1:8411 HERON POND DR APT B110
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972-8548
Practice Address - Country:US
Practice Address - Phone:239-288-9470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP532-541-55-349-0171W00000X, 171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
No171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP532-541-55-349-0OtherFLDL