1518176411 NPI number — SANDRA SARMIENTO MD PA

Table of content: (NPI 1518176411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518176411 NPI number — SANDRA SARMIENTO MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANDRA SARMIENTO MD PA
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:
6
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:
1518176411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 8665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORAL SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33075-8665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-984-8330
Provider Business Mailing Address Fax Number:
954-582-1205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 W MCNAB RD STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMARAC
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33321-5329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-582-1200
Provider Business Practice Location Address Fax Number:
954-582-1205
Provider Enumeration Date:
05/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARMIENTO
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
954-582-1200

Provider Taxonomy Codes

  • Taxonomy code: 261QH0100X , with the licence number:  ME74659 , 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: 253533500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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