Provider Demographics
NPI:1841015229
Name:NYDIA FUENTES LOPEZ
Entity type:Organization
Organization Name:NYDIA FUENTES LOPEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:ALBERTO
Authorized Official - Last Name:PARRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:987-873-8462
Mailing Address - Street 1:PO BOX 11597
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33339-1597
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CALLE BULBUL-EK MZ OS LT 12, GUERRA DE CASTAS
Practice Address - Street 2:
Practice Address - City:TULUM
Practice Address - State:QUINTANA ROO
Practice Address - Zip Code:77760
Practice Address - Country:MX
Practice Address - Phone:987-873-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance