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General NPI Number Information
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NPI Number | 1285095323
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Entity Type | Organization
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Legal Business Name | FABCONSULTING1CORP
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 6187 NW 167TH ST SUITE H 13
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City | HIALEAH
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State | FL
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Zip | 33015-4340
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Country | US
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Telephone | 786-502-2178
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Fax |
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Provider Business Mailing Address
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Address Line | 6187 NW 167TH ST SUITE H 13
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City | HIALEAH
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State | FL
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Zip | 33015-4340
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Country | US
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Telephone | 786-502-2178
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. BAUDILIO CUSCO-PRIETO
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Credential | M D
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Telephone | 786-502-2178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME 22691
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License Number State | FL
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