Provider Demographics
NPI:1629009675
Name:FABREGA, MARCO ANTONIO JR (MD)
Entity Type:Individual
Prefix:MR
First Name:MARCO
Middle Name:ANTONIO
Last Name:FABREGA
Suffix:JR
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 1:1097 S LE JEUNE RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33134-2639
Mailing Address - Country:US
Mailing Address - Phone:305-442-2021
Mailing Address - Fax:
Practice Address - Street 1:1097 S LE JEUNE RD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33134-2639
Practice Address - Country:US
Practice Address - Phone:305-442-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82033207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL269064100Medicaid
FLP00440595OtherRAILROAD MEDICARE
FLE6196MMedicare PIN
FLE70612Medicare UPIN
FLE6196OMedicare PIN
FLP00440595OtherRAILROAD MEDICARE
FLE6196NMedicare PIN