Provider Demographics
NPI:1336334564
Name:FUENTES, LILIA AZENETH (NP)
Entity Type:Individual
Prefix:MRS
First Name:LILIA
Middle Name:AZENETH
Last Name:FUENTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 THUNDERBIRD AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1719
Mailing Address - Country:US
Mailing Address - Phone:956-821-3978
Mailing Address - Fax:
Practice Address - Street 1:4115 PECAN BLVD STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-3695
Practice Address - Country:US
Practice Address - Phone:956-686-5060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111036363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily