Provider Demographics
NPI:1710911706
Name:ABREA, LETICIA ROSARIO (MD)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:ROSARIO
Last Name:ABREA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9860 BEACH BLVD STE A
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-4704
Mailing Address - Country:US
Mailing Address - Phone:904-642-9929
Mailing Address - Fax:
Practice Address - Street 1:9860 BEACH BLVD STE A
Practice Address - Street 2:UFJP PROVIDER ENROLLMENT
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4704
Practice Address - Country:US
Practice Address - Phone:904-642-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME90096208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2738651-00Medicaid
FL324712OtherHEALTHEASE ID