Provider Demographics
NPI:1053969691
Name:LLORENTE FUENTES, RAYBERT (MD)
Entity type:Individual
Prefix:DR
First Name:RAYBERT
Middle Name:
Last Name:LLORENTE FUENTES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:813-444-5838
Mailing Address - Fax:833-495-7206
Practice Address - Street 1:8201 N DALE MABRY HWY STE B2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2795
Practice Address - Country:US
Practice Address - Phone:813-933-7805
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-27
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR021528208D00000X
FLACN1248208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice