Provider Demographics
NPI:1215608849
Name:FUENTES, DANIEL RAMON (PSYD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:RAMON
Last Name:FUENTES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVE. SAN IGNACIO 22
Mailing Address - Street 2:APT. 707
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-459-6125
Mailing Address - Fax:
Practice Address - Street 1:AVE SAN IGNACIO 22
Practice Address - Street 2:APTO 707
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-0096
Practice Address - Country:US
Practice Address - Phone:787-459-6125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7104103TC1900X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling