1891793337 NPI number — DR. CARLOS A HANDAL-SACA M.D.

Table of content: DR. CARLOS A HANDAL-SACA M.D. (NPI 1891793337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891793337 NPI number — DR. CARLOS A HANDAL-SACA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HANDAL-SACA
Provider First Name:
CARLOS
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1891793337
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 W 16TH AVE
Provider Second Line Business Mailing Address:
STE.# 60
Provider Business Mailing Address City Name:
HIALEAH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33012-7194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-823-0721
Provider Business Mailing Address Fax Number:
305-823-2041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 W 16TH AVE
Provider Second Line Business Practice Location Address:
STE.# 60
Provider Business Practice Location Address City Name:
HIALEAH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-823-0721
Provider Business Practice Location Address Fax Number:
305-823-2041
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME0072355 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 160089 . This is a "STAY WELL PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 172504 . This is a "JMH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0025955 . This is a "NHP PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107395 . This is a "HUMANA PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 107396 . This is a "HUMANA PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 270390 . This is a "AVMED PROVIDER NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 592170298 . This is a "UNITED HEALTHCARE PROVIDE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: SG004535-F794 . This is a "VISTA HEALTH PLAN PROVIDE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 12-003353 . This is a "UNITED HEALTHCARE PROVIDE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259672500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 592170298 . This is a "TID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7303212 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 172497 . This is a "JMH PLAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 213316 . This is a "AMERIGROUP PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9441840001 . This is a "CIGNA PAL ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 259672501 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44267 . This is a "BC/BS PROVIDER #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 254044400 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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