Provider Demographics
NPI:1699874180
Name:SANCHEZ, BONNIE Z (DPM)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:Z
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 UPPER CREEK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-6844
Mailing Address - Country:US
Mailing Address - Phone:727-824-5100
Mailing Address - Fax:727-824-5132
Practice Address - Street 1:4040 UPPER CREEK DR STE 106
Practice Address - Street 2:
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-6844
Practice Address - Country:US
Practice Address - Phone:727-824-5100
Practice Address - Fax:727-824-5132
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1960213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00202506OtherRAILROAD MEDICARE
FL390379600Medicaid
FL4473390001Medicare NSC
FL390379600Medicaid
FL65496Medicare ID - Type Unspecified