Provider Demographics
NPI:1457718546
Name:FUENTES FLORES, SAMUEL ANIBAL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ANIBAL
Last Name:FUENTES FLORES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 4 BOX 41992
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-9737
Mailing Address - Country:US
Mailing Address - Phone:787-486-3060
Mailing Address - Fax:
Practice Address - Street 1:CARRETERA 2 KM 141.1 AVENIDA SEVERIANO CUEVAS 18
Practice Address - Street 2:BARRIO CAIMITAL BAJO
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00605
Practice Address - Country:US
Practice Address - Phone:787-658-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-21
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19457208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice