Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301111852 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 0063004 | CO |
N | 2080P0210X | Pediatric Nephrologist | 4301111852 | MI |
NPI | 1194080242 |
---|---|
Provider Name | Gabriel Miguel Cara Fuentes |
First Address | Aurora, CO 80042-0429 |
Second Address | Aurora, CO 80045-7106 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2012 |
Last Update Date | 27/12/2019 |