Healthcare Provider Details

I. General information

NPI: 1356519409
Provider Name (Legal Business Name): MARIANO MARTIN FARESI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 11/14/2025
Certification Date: 11/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16215 S JOG RD STE 204
DELRAY BEACH FL
33446-2386
US

IV. Provider business mailing address

PO BOX 20800
BELFAST ME
04915-4105
US

V. Phone/Fax

Practice location:
  • Phone: 561-448-3848
  • Fax: 561-501-3808
Mailing address:
  • Phone: 888-402-7256
  • Fax: 888-902-1099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberME96085
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: