Provider Demographics
NPI:1679003560
Name:FUENTES, CARMEN ANA
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:ANA
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 1:807 CALLE PRINCESA
Mailing Address - Street 2:URB MONACO 3
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674
Mailing Address - Country:US
Mailing Address - Phone:787-447-7769
Mailing Address - Fax:
Practice Address - Street 1:CARR. 2 KM 57.5
Practice Address - Street 2:113 BO CRUCE DAVILA
Practice Address - City:BARCELONETA
Practice Address - State:PR
Practice Address - Zip Code:00617-3130
Practice Address - Country:US
Practice Address - Phone:787-846-6307
Practice Address - Fax:787-846-5084
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-14
Last Update Date:2017-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist