Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME88300 | FL |
NPI | 1003891656 |
---|---|
Provider Name | Mr. Juan Carlos Sanchez |
First Address | Tamarac, FL 33321-2954 |
Second Address | Tamarac, FL 33321-2954 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2005 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
268087401 | (05) | FL |
81463Z | MEDICARE (01) | |
H94739 | (02) |