Provider Demographics
NPI:1912522657
Name:FUENTES, MARIA VICTORIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:VICTORIA
Last Name:FUENTES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4133 NW 200TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-1344
Mailing Address - Country:US
Mailing Address - Phone:786-488-5726
Mailing Address - Fax:
Practice Address - Street 1:4133 NW 200TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-1344
Practice Address - Country:US
Practice Address - Phone:786-488-5726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-09
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician