Provider Demographics
NPI:1932546546
Name:FUENTES, AURA S (MD)
Entity Type:Individual
Prefix:DR
First Name:AURA
Middle Name:S
Last Name: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 1:4401 EMERSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-4954
Mailing Address - Country:US
Mailing Address - Phone:904-399-8884
Mailing Address - Fax:313-332-1857
Practice Address - Street 1:4401 EMERSON ST STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-4954
Practice Address - Country:US
Practice Address - Phone:904-399-8884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-23
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301114482208D00000X
FLME155244208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice