Provider Demographics
NPI:1629613559
Name:FUENTES, EILEEN E
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:E
Last Name: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 1:12714 MOSS PARK RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7086
Mailing Address - Country:US
Mailing Address - Phone:407-864-6494
Mailing Address - Fax:
Practice Address - Street 1:12714 MOSS PARK RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7086
Practice Address - Country:US
Practice Address - Phone:407-864-6494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management