Organization
FUENTES COSMETIC FACILITY INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CANDIDO E FUENTES MD (PRESIDENT)
(631) 385-9381
Entity
Organization
Contact information
Practice address
120 NEW YORK AVE, 1W, HUNTINGTON, NY 11743-2743
(631) 385-9381
(631) 385-4372
Mailing address
120 NEW YORK AVE, SUITE 1W, HUNTINGTON, NY 11743-2743
(631) 385-9381
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
07/10/2009
Last updated
07/10/2009
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