Provider Demographics
NPI:1679163695
Name:ABREU FAURE, PEDRO ELIAM (SA-C)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:ELIAM
Last Name:ABREU FAURE
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10585 NOAHS CIR APT 314
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34116-8349
Mailing Address - Country:US
Mailing Address - Phone:503-995-7442
Mailing Address - Fax:
Practice Address - Street 1:10585 NOAHS CIR APT 314
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34116-8349
Practice Address - Country:US
Practice Address - Phone:503-995-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-23
Last Update Date:2021-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20-519246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant