Provider Demographics
NPI:1528131091
Name:SANZ, VIANCA C (LDO)
Entity type:Individual
Prefix:MS
First Name:VIANCA
Middle Name:C
Last Name:SANZ
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 NW 79TH AVE
Mailing Address - Street 2:BLDG 3, SUITE 336
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6556
Mailing Address - Country:US
Mailing Address - Phone:305-392-3173
Mailing Address - Fax:305-591-1712
Practice Address - Street 1:3900 NW 79TH AVE
Practice Address - Street 2:BLDG 3, SUITE 336
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6556
Practice Address - Country:US
Practice Address - Phone:305-392-3173
Practice Address - Fax:305-591-1712
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO02733156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician