Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME31278 | FL |
N | 207QA0505X | Family Doctor - Adult Medicine | ME31278 | FL |
NPI | 1295718245 |
---|---|
Provider Name | Cesar Fernandez Sarmiento |
First Address | Leesburg, FL 34749-0570 |
Second Address | Leesburg, FL 34748 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/11/2005 |
Last Update Date | 28/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02122 | BCBSFL (01) | FL |
D50345 | (02) | FL |