Individual
IVIS S FUENTES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ITFS
Contact information
Practice address
123 HARRIS RD, SMITHFIELD, NC 27577-8161
(919) 437-2156
Mailing address
123 HARRIS RD, SMITHFIELD, NC 27577-8161
(919) 437-2156
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/12/2013
Last updated
04/12/2013
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