Provider Demographics
NPI:1932564390
Name:ENCINOSA, SERGIO ANTONIO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ANTONIO
Last Name:ENCINOSA
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 1:5949 BAYVIEW CIR S
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33707-3929
Mailing Address - Country:US
Mailing Address - Phone:786-351-1589
Mailing Address - Fax:
Practice Address - Street 1:12890 POINSETTIA AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-4317
Practice Address - Country:US
Practice Address - Phone:786-351-1589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-29
Last Update Date:2016-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist