1154657260 NPI number — MEDICA HEALTH PLANS OF FLORIDA, INC.

Table of content: JOHN GERARD SANCHEZ LISW, BCD (NPI 1366635278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154657260 NPI number — MEDICA HEALTH PLANS OF FLORIDA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICA HEALTH PLANS OF FLORIDA, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1154657260
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4000 PONCE DE LEON BLVD
Provider Second Line Business Mailing Address:
STE 650
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33146-1431
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-460-0600
Provider Business Mailing Address Fax Number:
305-460-0613

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 PONCE DE LEON BLVD
Provider Second Line Business Practice Location Address:
STE 650
Provider Business Practice Location Address City Name:
CORAL GABLES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33146-1431
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-460-0600
Provider Business Practice Location Address Fax Number:
305-460-0613
Provider Enumeration Date:
10/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MORALEJO
Authorized Official First Name:
JOSE
Authorized Official Middle Name:
I
Authorized Official Title or Position:
DIRECTOR - SUPPORT SERVICES
Authorized Official Telephone Number:
305-460-0600

Provider Taxonomy Codes

  • Taxonomy code: 302R00000X , 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)





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