Provider Demographics
NPI:1659184281
Name:FUENTES ALVAREZ, GLORYNETTE (PA)
Entity type:Individual
Prefix:
First Name:GLORYNETTE
Middle Name:
Last Name:FUENTES ALVAREZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB. BAIROA PARK
Mailing Address - Street 2:C/ PARQUE DEL CONDADO K6
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00727
Mailing Address - Country:US
Mailing Address - Phone:787-692-5242
Mailing Address - Fax:
Practice Address - Street 1:URB. BAIROA PARK
Practice Address - Street 2:C/ PARQUE DEL CONDADO K6
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00727
Practice Address - Country:US
Practice Address - Phone:787-692-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR949363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical