Provider Demographics
NPI:1710355854
Name:FUENTES, LORNA
Entity Type:Individual
Prefix:
First Name:LORNA
Middle Name:
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 1:2201 NW 23RD ST
Mailing Address - Street 2:# 348
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33142-8495
Mailing Address - Country:US
Mailing Address - Phone:305-988-0543
Mailing Address - Fax:
Practice Address - Street 1:2201 NW 23RD ST
Practice Address - Street 2:# 348
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33142-8495
Practice Address - Country:US
Practice Address - Phone:305-988-0543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-07
Last Update Date:2015-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency