Provider Demographics
NPI:1730632472
Name:FUENTES, DEBORAH (LM, CPM)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1935 MARASCO LN
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-7647
Mailing Address - Country:US
Mailing Address - Phone:941-264-6084
Mailing Address - Fax:570-227-2306
Practice Address - Street 1:1935 MARASCO LN
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-7647
Practice Address - Country:US
Practice Address - Phone:941-264-6084
Practice Address - Fax:570-227-2306
Is Sole Proprietor?:No
Enumeration Date:2016-07-29
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW328176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife