Provider Demographics
NPI:1649760604
Name:CIFUENTES, ADELA PATRICIA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ADELA
Middle Name:PATRICIA
Last Name:CIFUENTES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:CIFUENTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:855 DAVIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-8244
Mailing Address - Country:US
Mailing Address - Phone:817-912-1771
Mailing Address - Fax:940-841-6756
Practice Address - Street 1:855 DAVIS BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-8244
Practice Address - Country:US
Practice Address - Phone:817-912-1771
Practice Address - Fax:940-841-6756
Is Sole Proprietor?:No
Enumeration Date:2018-05-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine