Provider Demographics
NPI:1568244945
Name:LANDRAU FUENTES, ISABEL ALEJANDRA
Entity Type:Individual
Prefix:
First Name:ISABEL
Middle Name:ALEJANDRA
Last Name:LANDRAU FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 VALLE DE STA OLAYA
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00956-9465
Mailing Address - Country:US
Mailing Address - Phone:787-426-5951
Mailing Address - Fax:
Practice Address - Street 1:977 CLL SAN ROBERTO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PA
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-773-6501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program