Individual
CARMEN ROXANA FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6161 KEMPSVILLE CIR, SUITE 315, NORFOLK, VA 23502-3932
(757) 461-5400
(757) 461-3305
Mailing address
6161 KEMPSVILLE CIR, SUITE 315, NORFOLK, VA 23502-3932
(757) 461-5400
(757) 461-3305
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
0101248444
VA
2084N0400X
Neurology Physician
Primary
MD.202662
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07480774
—
MS
05
—
1507555
—
LA
Enumeration date
08/10/2007
Last updated
09/24/2010
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