Provider Demographics
NPI:1912249897
Name:CADIZ FUENTES, CARLENE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:MARIE
Last Name:CADIZ FUENTES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MANSIONES REALES
Mailing Address - Street 2:CALLE FERNANDO I A 32
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-925-5550
Mailing Address - Fax:787-925-5550
Practice Address - Street 1:100 CALLE JOSE C VAZQUEZ
Practice Address - Street 2:
Practice Address - City:AIBONITO
Practice Address - State:PR
Practice Address - Zip Code:00705-3309
Practice Address - Country:US
Practice Address - Phone:787-925-5550
Practice Address - Fax:787-925-5550
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-19
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19563207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology