Provider Demographics
NPI:1568048577
Name:FUENTES, HECTOR JOEL
Entity Type:Individual
Prefix:
First Name:HECTOR
Middle Name:JOEL
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 1:2550 AVE DE DIEGO
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00987-4800
Mailing Address - Country:US
Mailing Address - Phone:787-619-2329
Mailing Address - Fax:
Practice Address - Street 1:2550 AVE DE DIEGO
Practice Address - Street 2:
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00987-4800
Practice Address - Country:US
Practice Address - Phone:787-762-8412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
9200183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician