Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | ME116179 | FL |
N | 111NI0900X | Internist | ME116179 | FL |
N | 207RH0000X | Hematologist | ME116179 | FL |
Y | 207RH0003X | Hematology & Oncology | ME116179 | FL |
NPI | 1174846158 |
---|---|
Provider Name | Jose David Sandoval-Sus |
First Address | Miramar, FL 33025-3925 |
Second Address | Pembroke Pines, FL 33028-1021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/03/2010 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
021103800 | (05) | FL |