Provider Demographics
NPI:1710165758
Name:FABRE, ENRIQUE (LMT MA30924)
Entity Type:Individual
Prefix:MRS
First Name:ENRIQUE
Middle Name:
Last Name:FABRE
Suffix:
Gender:M
Credentials:LMT MA30924
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6919 W 36 AV
Mailing Address - Street 2:#202
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018
Mailing Address - Country:US
Mailing Address - Phone:786-271-5562
Mailing Address - Fax:305-825-8667
Practice Address - Street 1:6919 W 36 AV
Practice Address - Street 2:#202
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018
Practice Address - Country:US
Practice Address - Phone:786-271-5562
Practice Address - Fax:305-825-8667
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30924225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist