1801974548 NPI number — SANCHEZ DE FUENTES AND REAL MD PA

Table of content: (NPI 1801974548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801974548 NPI number — SANCHEZ DE FUENTES AND REAL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANCHEZ DE FUENTES AND REAL 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:
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:
1801974548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1170 CYPRESS GLEN CIR
Provider Second Line Business Mailing Address:
HUNTER'S CREEK PROFESSIONAL PARK
Provider Business Mailing Address City Name:
KISSIMMEE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34741-7560
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-847-6166
Provider Business Mailing Address Fax Number:
407-847-5112

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1170 CYPRESS GLEN CIRCLE
Provider Second Line Business Practice Location Address:
HUNTER'S CREEK PROFESSIONAL PARK
Provider Business Practice Location Address City Name:
KISSIMMEE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34741-4998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-847-6166
Provider Business Practice Location Address Fax Number:
407-847-5112
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
REAL
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
407-847-6166

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  ME0063371 , 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: 376506700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DB00330 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1174528236 . This is a "PERSONAL NPI NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K351 . This is a "MEDICARE GROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: ME0063371 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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