Provider Demographics
NPI:1144759515
Name:LA FUENTE, MONIQUE (OCULARIST)
Entity type:Individual
Prefix:
First Name:MONIQUE
Middle Name:
Last Name:LA FUENTE
Suffix:
Gender:F
Credentials:OCULARIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3215 SE PINTO ST
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-6506
Mailing Address - Country:US
Mailing Address - Phone:405-774-0118
Mailing Address - Fax:
Practice Address - Street 1:229 NW 9TH ST # 102
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2619
Practice Address - Country:US
Practice Address - Phone:405-774-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-08
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist