Provider Demographics
NPI:1306270509
Name:SANJUAN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:SANJUAN
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 1:737 S SEMORAN BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-3121
Mailing Address - Country:US
Mailing Address - Phone:321-247-4960
Mailing Address - Fax:833-963-0116
Practice Address - Street 1:737 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-3121
Practice Address - Country:US
Practice Address - Phone:321-247-4960
Practice Address - Fax:833-963-0116
Is Sole Proprietor?:No
Enumeration Date:2013-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15442208D00000X
FLACN1047208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100951000Medicaid
FLACN1047OtherSTATE LICENSE
FLPV866OtherMEDICARE
FLFS4277720OtherDEA