1285620088 NPI number — DR. FABRICCIO MELANIO LETELLIER M.D.

Table of content: DR. FABRICCIO MELANIO LETELLIER M.D. (NPI 1285620088)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285620088 NPI number — DR. FABRICCIO MELANIO LETELLIER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LETELLIER
Provider First Name:
FABRICCIO
Provider Middle Name:
MELANIO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285620088
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8600 SW 92ND ST
Provider Second Line Business Mailing Address:
STE 204A
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33156-7397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-436-9933
Provider Business Mailing Address Fax Number:
305-436-9944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8750 SW 144TH ST
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
PALMETTO BAY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-7296
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-259-6166
Provider Business Practice Location Address Fax Number:
305-259-6630
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  ME79333 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 263573900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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