Provider Demographics
NPI:1407147598
Name:FABIAN FONTAINE FIGUEREDO MD CORP
Entity Type:Organization
Organization Name:FABIAN FONTAINE FIGUEREDO MD CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FABIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FONTAINE FIGUEREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-335-0607
Mailing Address - Street 1:6703 SW 105TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-1365
Mailing Address - Country:US
Mailing Address - Phone:305-335-0607
Mailing Address - Fax:305-663-5882
Practice Address - Street 1:6703 SW 105TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1365
Practice Address - Country:US
Practice Address - Phone:305-335-0607
Practice Address - Fax:305-663-5882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty