Provider Demographics
NPI:1861810020
Name:FUENTES, PATRICIA (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 NW 176TH TER
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-7158
Mailing Address - Country:US
Mailing Address - Phone:786-553-7607
Mailing Address - Fax:
Practice Address - Street 1:18822 NW 80TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-5228
Practice Address - Country:US
Practice Address - Phone:305-904-0285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-03
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ6441235Z00000X
FLSA13367235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12316300Medicaid
FL010929100Medicaid