Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | PY9302 | FL |
N | 103TC0700X | Clinical Psychologist | PY9302 | FL |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1073908224 |
---|---|
Provider Name | Dr. David Fuentes |
First Address | Naples, FL 34116-7536 |
Second Address | Naples, FL 34116-7536 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2015 |
Last Update Date | 15/04/2019 |