Healthcare Provider Details

I. General information

NPI: 1457074148
Provider Name (Legal Business Name): WILLY SANON RT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 CORAL SPRINGS DR APT 108
CORAL SPRINGS FL
33065-3855
US

IV. Provider business mailing address

3200 CORAL SPRINGS DR APT 108
CORAL SPRINGS FL
33065-3855
US

V. Phone/Fax

Practice location:
  • Phone: 561-213-4964
  • Fax:
Mailing address:
  • Phone: 561-213-4964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT11588
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: