Provider Demographics
NPI:1700072949
Name:ARMANDO FUENTES, MD PA
Entity Type:Organization
Organization Name:ARMANDO FUENTES, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARMANDO
Authorized Official - Middle Name:
Authorized Official - Last Name:FUENTES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-644-9797
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0817
Mailing Address - Country:US
Mailing Address - Phone:407-644-9797
Mailing Address - Fax:407-644-8377
Practice Address - Street 1:147 MORAY LN
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-4120
Practice Address - Country:US
Practice Address - Phone:407-644-9797
Practice Address - Fax:407-644-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48481174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K3102Medicare PIN
FLD84806Medicare UPIN