Provider Demographics
NPI:1982731105
Name:FUENTES, LUIS A SR
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:A
Last Name:FUENTES
Suffix:SR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HC 72 BOX 4021
Mailing Address - Street 2:
Mailing Address - City:NARANJITO
Mailing Address - State:PR
Mailing Address - Zip Code:00719-9794
Mailing Address - Country:US
Mailing Address - Phone:787-857-2506
Mailing Address - Fax:
Practice Address - Street 1:40 CALLE GEORGETTI
Practice Address - Street 2:
Practice Address - City:COMERIO
Practice Address - State:PR
Practice Address - Zip Code:00782-2537
Practice Address - Country:US
Practice Address - Phone:787-875-2121
Practice Address - Fax:787-875-2245
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist