Provider Demographics
NPI:1710345681
Name:FUENTES, ELKI JULIETTA
Entity Type:Individual
Prefix:
First Name:ELKI
Middle Name:JULIETTA
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 1:1800 E SPRING CREEK PKWY
Mailing Address - Street 2:APT#922
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-3200
Mailing Address - Country:US
Mailing Address - Phone:972-375-1106
Mailing Address - Fax:
Practice Address - Street 1:1800 E SPRING CREEK PKWY
Practice Address - Street 2:APT#922
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-3200
Practice Address - Country:US
Practice Address - Phone:972-375-1106
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-05
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide