Healthcare Provider Details

I. General information

NPI: 1710911706
Provider Name (Legal Business Name): LETICIA ROSARIO ABREA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9860 BEACH BLVD STE A UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32246-4704
US

IV. Provider business mailing address

9860 BEACH BLVD STE A UFJP PROVIDER ENROLLMENT
JACKSONVILLE FL
32246-4704
US

V. Phone/Fax

Practice location:
  • Phone: 904-642-9929
  • Fax:
Mailing address:
  • Phone: 904-642-9929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: