Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 11005401 | FL |
NPI | 1083253496 |
---|---|
Provider Name | Jany Fuentes |
First Address | Miami, FL 33125-1840 |
Second Address | Miami, FL 33146-2008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2020 |
Last Update Date | 02/01/2020 |