Provider Demographics
NPI:1730958844
Name:FUENTES PEREZ, ARLIS
Entity type:Individual
Prefix:
First Name:ARLIS
Middle Name:
Last Name:FUENTES PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15985 PRESERVE MARKETPLACE #1018
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556
Mailing Address - Country:US
Mailing Address - Phone:813-373-2606
Mailing Address - Fax:
Practice Address - Street 1:15985 PRESERVE MARKETPLACE #1018
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556
Practice Address - Country:US
Practice Address - Phone:813-373-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL23-0-129143342000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes342000000XTransportation ServicesTransportation Network Company