Healthcare Provider Details

I. General information

NPI: 1518875996
Provider Name (Legal Business Name): FABIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2026
Last Update Date: 08/28/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 AVE JOSE GAUTIER BENITEZ SUITE 307 CONSOLIDATED MEDICAL PLAZA
CAGUAS PR
00725-5527
US

IV. Provider business mailing address

690 CALLE CESAR GONZALEZ APT 2303
SAN JUAN PR
00918-3907
US

V. Phone/Fax

Practice location:
  • Phone: 787-746-7441
  • Fax:
Mailing address:
  • Phone: 573-825-8673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: FABIO SQUICIMARI DE CARDENAS
Title or Position: OWNER
Credential: MD
Phone: 573-825-8673