Provider Demographics
NPI:1386971802
Name:MANUEL SANCHEZ PA
Entity type:Organization
Organization Name:MANUEL SANCHEZ PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:786-399-9944
Mailing Address - Street 1:7410 LOCH NESS DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6012
Mailing Address - Country:US
Mailing Address - Phone:786-399-9944
Mailing Address - Fax:
Practice Address - Street 1:5385 W 20TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2101
Practice Address - Country:US
Practice Address - Phone:305-698-1215
Practice Address - Fax:305-698-1216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-04
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067711208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL377284500Medicaid
FLF99943Medicare UPIN
FL26732AMedicare PIN