Provider Demographics
NPI:1427757939
Name:FERNANDEZ PUIG, MARIA LORETO
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LORETO
Last Name:FERNANDEZ PUIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:834 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:DEFUNIAK SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32433-8352
Mailing Address - Country:US
Mailing Address - Phone:224-623-7388
Mailing Address - Fax:
Practice Address - Street 1:834 N 1ST ST
Practice Address - Street 2:
Practice Address - City:DEFUNIAK SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32433-8352
Practice Address - Country:US
Practice Address - Phone:224-623-7388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-23
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No171R00000XOther Service ProvidersInterpreter
No172A00000XOther Service ProvidersDriver