Provider Demographics
NPI:1194759928
Name:SANCHEZ-FORTIS, ALFREDO (MD)
Entity type:Individual
Prefix:
First Name:ALFREDO
Middle Name:
Last Name:SANCHEZ-FORTIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9999 NE 2ND AVE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:305-756-4400
Mailing Address - Fax:305-756-4484
Practice Address - Street 1:9999 NE 2ND AVE
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-756-4400
Practice Address - Fax:305-756-4484
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME64654OtherMEDICAL LICENSE
FL25435OtherBCBS PROVIDER
FL375466900Medicaid
FL375466900Medicaid
FL25435YMedicare Oscar/Certification
FL25435OtherBCBS PROVIDER
FL25435AMedicare ID - Type Unspecified