Provider Demographics
NPI:1962814558
Name:PUENTE FUMERO, PABLO ODELEY (MD)
Entity Type:Individual
Prefix:DR
First Name:PABLO
Middle Name:ODELEY
Last Name:PUENTE FUMERO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE PABLO NERUDA 57
Mailing Address - Street 2:10-F
Mailing Address - City:MADRID
Mailing Address - State:MADRID
Mailing Address - Zip Code:28018
Mailing Address - Country:ES
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1228 MILAN AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3504
Practice Address - Country:US
Practice Address - Phone:703-501-8550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-29
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH14595101YM0800X, 103K00000X
103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst