Provider Demographics
NPI:1922571926
Name:DE LA FUENTE, ADRIANA (PA)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:DE LA FUENTE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 WEST DR APT 214
Mailing Address - Street 2:
Mailing Address - City:NORTH BAY VILLAGE
Mailing Address - State:FL
Mailing Address - Zip Code:33141-5539
Mailing Address - Country:US
Mailing Address - Phone:786-209-9602
Mailing Address - Fax:
Practice Address - Street 1:8905 SW 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-2210
Practice Address - Country:US
Practice Address - Phone:305-667-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant