Provider Demographics
NPI:1972611440
Name:FUENTES, ANDRES R (MD)
Entity type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:R
Last Name:FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NOGAL ST # 108 URB SAN RAMOS
Mailing Address - Street 2:
Mailing Address - City:GUDYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969
Mailing Address - Country:US
Mailing Address - Phone:787-746-7142
Mailing Address - Fax:787-746-7142
Practice Address - Street 1:PLAZA BAIROA SUITE 204 UIUA BLANCA
Practice Address - Street 2:
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-746-7142
Practice Address - Fax:787-746-7142
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRPR8458208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
G41777Medicare UPIN
29636Medicare ID - Type Unspecified