Provider Demographics
NPI:1194967919
Name:CIFUENTES, FELIPE (BA)
Entity type:Individual
Prefix:MR
First Name:FELIPE
Middle Name:
Last Name:CIFUENTES
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 SANS SOUCI BLVD APT 702
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3010
Mailing Address - Country:US
Mailing Address - Phone:305-285-2294
Mailing Address - Fax:305-860-4678
Practice Address - Street 1:2150 SANS SOUCI BLVD APT 702
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33181-3010
Practice Address - Country:US
Practice Address - Phone:305-285-2294
Practice Address - Fax:305-860-4678
Is Sole Proprietor?:No
Enumeration Date:2009-03-25
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000608300Medicaid