Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | ME55384 | FL |
NPI | 1235260746 |
---|---|
Provider Name | Dr. Mario Rolando Sanchez |
First Address | Miami, FL 33156-2678 |
Second Address | Kissimmee, FL 34744-4428 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/03/2007 |
Last Update Date | 26/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
037963804 | (05) | FL |
A62455 | (02) | FL |