Provider Demographics
NPI:1912479130
Name:SANON, JEAN S
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:S
Last Name:SANON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9098 PARAGON WAY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-5112
Mailing Address - Country:US
Mailing Address - Phone:561-502-6289
Mailing Address - Fax:561-491-5519
Practice Address - Street 1:3020 HIGH RIDGE RD STE 600
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8731
Practice Address - Country:US
Practice Address - Phone:561-810-2635
Practice Address - Fax:561-491-5519
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician