Provider Demographics
NPI:1184810962
Name:RICCI GORBEA, FABIO (MD)
Entity type:Individual
Prefix:DR
First Name:FABIO
Middle Name:
Last Name:RICCI GORBEA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FABIO
Other - Middle Name:
Other - Last Name:RICCI GORBEA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 BO TORTUGO APT 123
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-9773
Mailing Address - Country:US
Mailing Address - Phone:787-938-7014
Mailing Address - Fax:
Practice Address - Street 1:400 BO TORTUGO APT 123
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9773
Practice Address - Country:US
Practice Address - Phone:787-938-7014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR17957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine