1306291372 NPI number — DR. CARLOS IVAN SANCHEZ MD,CRNA,RN

Table of content: DR. CARLOS IVAN SANCHEZ MD,CRNA,RN (NPI 1306291372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306291372 NPI number — DR. CARLOS IVAN SANCHEZ MD,CRNA,RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
CARLOS
Provider Middle Name:
IVAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD,CRNA,RN
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:
1306291372
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
283 HACIENDA SAN JOSE
Provider Second Line Business Mailing Address:
VILLA CARIBE
Provider Business Mailing Address City Name:
CAGUAS
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-629-4502
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11913 AUTUMN FERN LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLANDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-288-3785
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/27/2016

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: 367500000X , with the licence number:  9451817 , 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: 023256600 . 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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