Provider Demographics
NPI:1336680321
Name:FABREGAS RODRIGUEZ, OMAR JOSE (DC)
Entity Type:Individual
Prefix:DR
First Name:OMAR
Middle Name:JOSE
Last Name:FABREGAS RODRIGUEZ
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 AVE LUIS MUNOZ MARIN VILLA BLANCA
Mailing Address - Street 2:PMB 309
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-662-0973
Mailing Address - Fax:
Practice Address - Street 1:146 CALLE DEL PARQUE
Practice Address - Street 2:
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00911-1919
Practice Address - Country:US
Practice Address - Phone:787-722-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-10
Last Update Date:2017-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0630111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor