Provider Demographics
NPI:1588993182
Name:FUENTEZ, ARIZ PETER (MA CCC/SLP)
Entity type:Individual
Prefix:MR
First Name:ARIZ
Middle Name:PETER
Last Name:FUENTEZ
Suffix:
Gender:M
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SCOTCHPINE DR
Mailing Address - Street 2:
Mailing Address - City:ISLANDIA
Mailing Address - State:NY
Mailing Address - Zip Code:11749-1605
Mailing Address - Country:US
Mailing Address - Phone:631-439-0595
Mailing Address - Fax:631-439-0595
Practice Address - Street 1:66 SCOTCHPINE DR
Practice Address - Street 2:
Practice Address - City:ISLANDIA
Practice Address - State:NY
Practice Address - Zip Code:11749-1605
Practice Address - Country:US
Practice Address - Phone:631-439-0595
Practice Address - Fax:631-439-0595
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2009-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist