Provider Demographics
NPI:1619080819
Name:FUENMAYOR, LORENA DEL VALLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LORENA
Middle Name:DEL VALLE
Last Name:FUENMAYOR
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 1:101 S REDLAND RD
Mailing Address - Street 2:
Mailing Address - City:FLORIDA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33034-4630
Mailing Address - Country:US
Mailing Address - Phone:305-246-2844
Mailing Address - Fax:305-246-2822
Practice Address - Street 1:101 S REDLAND RD
Practice Address - Street 2:
Practice Address - City:FLORIDA CITY
Practice Address - State:FL
Practice Address - Zip Code:33034-4630
Practice Address - Country:US
Practice Address - Phone:305-246-2844
Practice Address - Fax:305-246-2822
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN 211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR13.651OtherMEDICAL LICENSE
FLACN 211OtherMEDICAL LICENSE
PR0020402Medicare UPIN
FLACN 211OtherMEDICAL LICENSE