Basic Information
| Provider Information | |||||||||
| NPI: | 1932843851 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FUENTES MARTINEZ | ||||||||
| FirstName: | ARALIS | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2100 SAWMILL RD APT 21201 | ||||||||
| Address2: | |||||||||
| City: | RIVER RIDGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 701235965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7873628424 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2055 KIMBALL AVE STE 101 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192722112 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2022 | ||||||||
| LastUpdateDate: | 04/26/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | R-12389 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.