Provider Demographics
NPI:1972230431
Name:FUENTES MEDICAL CENTER INC
Entity Type:Organization
Organization Name:FUENTES MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:CAMEJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-584-8531
Mailing Address - Street 1:18400 NW 75TH PL STE 116
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2956
Mailing Address - Country:US
Mailing Address - Phone:786-584-8531
Mailing Address - Fax:
Practice Address - Street 1:18400 NW 75TH PL STE 116
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2956
Practice Address - Country:US
Practice Address - Phone:786-584-8531
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty