Basic Information
| Provider Information | |||||||||
| NPI: | 1891366969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DE LA FUENTE | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | LIANA | ||||||||
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| Credential: | AU.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8181 NW 154TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | MIAMI LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330165861 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055583724 | ||||||||
| FaxNumber: | 7869074485 | ||||||||
| Practice Location | |||||||||
| Address1: | 6705 S RED RD STE 704 | ||||||||
| Address2: | |||||||||
| City: | SOUTH MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331433652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7863862076 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2021 | ||||||||
| LastUpdateDate: | 08/04/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | AY2483 | FL | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.