Provider Demographics
NPI:1285620088
Name:LETELLIER, FABRICCIO MELANIO (MD)
Entity type:Individual
Prefix:DR
First Name:FABRICCIO
Middle Name:MELANIO
Last Name:LETELLIER
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Gender:M
Credentials:MD
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Mailing Address - Street 1:8600 SW 92ND ST
Mailing Address - Street 2:STE 204A
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-7397
Mailing Address - Country:US
Mailing Address - Phone:305-436-9933
Mailing Address - Fax:305-436-9944
Practice Address - Street 1:8750 SW 144TH ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33176-7296
Practice Address - Country:US
Practice Address - Phone:305-259-6166
Practice Address - Fax:305-259-6630
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2022-01-31
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Provider Licenses
StateLicense IDTaxonomies
FLME79333207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263573900Medicaid
FLH16216Medicare UPIN
FL263573900Medicaid