Provider Demographics
NPI:1578864294
Name:BRUNET FUENTES, KISHA CHRISTINA (MD)
Entity Type:Individual
Prefix:
First Name:KISHA
Middle Name:CHRISTINA
Last Name:BRUNET FUENTES
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:CALLE SAN LUCAS 1394
Mailing Address - Street 2:ALTA MESA
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00921-4316
Mailing Address - Country:US
Mailing Address - Phone:787-662-6439
Mailing Address - Fax:
Practice Address - Street 1:1394 CALLE SAN LUCAS
Practice Address - Street 2:ALTA MESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4316
Practice Address - Country:US
Practice Address - Phone:787-662-6439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18510208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics