Provider Demographics
NPI:1700820024
Name:FUENTES, LUIS (AP)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:
Last Name:FUENTES
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9420 SW 77TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7988
Mailing Address - Country:US
Mailing Address - Phone:305-412-0011
Mailing Address - Fax:305-412-3837
Practice Address - Street 1:9420 SW 77TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-7988
Practice Address - Country:US
Practice Address - Phone:305-412-0011
Practice Address - Fax:305-412-3837
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP000791171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC0308OtherBC/BS PROVIDER NUMBER