Healthcare Provider Details

I. General information

NPI: 1124194311
Provider Name (Legal Business Name): HANDAL SACA PEDIATRICS M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE SUITE # 60
HIALEAH FL
33012-7194
US

IV. Provider business mailing address

4410 W 16TH AVE SUITE # 60
HIALEAH FL
33012-7194
US

V. Phone/Fax

Practice location:
  • Phone: 305-823-0721
  • Fax: 305-823-2041
Mailing address:
  • Phone: 305-823-0721
  • Fax: 305-823-2041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME-0072355
License Number StateFL

VIII. Authorized Official

Name: DR. CARLOS A HANDAL SACA
Title or Position: MEDICAL DOCTOR OWNER
Credential: MD
Phone: 305-823-0721