Search › Arizona › 390200000X
Mariela Cuebas Fantauzzi, MD
NPI 1629571146 · on the registry since 2018 · sole proprietor
Practice
- Address
- 13995 W Statler Blvd Ste 200
Surprise, AZ 85374 - Phone
- (602) 478-3100
- Organisation at this address
- Richard Lee Averitte Jr., Pllc
Banner Physician Specialists Arizona Llc
Banner Primary Care Physicians Arizona LlcInferred from a shared address, not stated in the registry. - Clinicians at this address
- 59
Additional practice sites
- Carr 135 Km 4.5, Lares, PR
- 950 County Road 17a W, Avon Park, FL
- 1156 Calle 62 Se, San Juan, PR
Registry record
- Primary taxonomy
- 390200000X
390200000X
- Also registered as
- 208D00000X
390200000X
208D00000X - Licence states on file
- AZ, PR, FL
From the registry's licence fields, which are often incomplete.
- Sex
- Female
- Record last updated
- 2026-06-03
Source: CMS National Plan and Provider Enumeration System. Registration is not the same as practising, and the registry records no retirement — some people listed here no longer practise. More in Arizona