Provider Demographics
NPI:1891107728
Name:PUENTE, ANTONIO NICOLAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTONIO
Middle Name:NICOLAS
Last Name:PUENTE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12916 CHESWOOD LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-1648
Mailing Address - Country:US
Mailing Address - Phone:910-233-9853
Mailing Address - Fax:
Practice Address - Street 1:2120 L ST NW
Practice Address - Street 2:SUITE 600
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-1527
Practice Address - Country:US
Practice Address - Phone:910-233-9853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist