Provider Demographics
NPI:1750771556
Name:DORREGO, FERNANDO ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:ANTONIO
Last Name:DORREGO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:FERNANDO
Other - Middle Name:
Other - Last Name:DORREGO BENITEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:15516 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1554
Practice Address - Country:US
Practice Address - Phone:305-387-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-31
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52620207R00000X
FL148723207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine