Provider Demographics
NPI:1255761219
Name:FUENTES, MIGUEL ARMANDO (LMT)
Entity type:Individual
Prefix:MR
First Name:MIGUEL
Middle Name:ARMANDO
Last Name:FUENTES
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12210 NE 11TH PL
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-5813
Mailing Address - Country:US
Mailing Address - Phone:786-487-3138
Mailing Address - Fax:
Practice Address - Street 1:434 SW 12TH AVE
Practice Address - Street 2:SUITE306
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33130-2440
Practice Address - Country:US
Practice Address - Phone:305-644-7662
Practice Address - Fax:305-644-9481
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-12
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA55581225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist