Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 214140 | MA |
N | 2080P0207X | Pediatric Hematology-Oncologist | 214140 | MA |
NPI | 1174511265 |
---|---|
Provider Name | Dr. Karla P Fuentes |
First Address | Pawtucket, RI 02860-4010 |
Second Address | Pawtucket, RI 02860-4010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2005 |
Last Update Date | 11/08/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2001926 | (05) | MA |
H79300 | (02) |