Provider Demographics
NPI:1679256580
Name:MARQUEZ FABRE, ALEXEI
Entity Type:Individual
Prefix:
First Name:ALEXEI
Middle Name:
Last Name:MARQUEZ FABRE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6005 GUMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-1655
Mailing Address - Country:US
Mailing Address - Phone:904-422-4765
Mailing Address - Fax:
Practice Address - Street 1:9250 CYPRESS GREEN DR STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-5514
Practice Address - Country:US
Practice Address - Phone:904-422-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-08
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA100474225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist