Healthcare Provider Details

I. General information

NPI: 1891793337
Provider Name (Legal Business Name): CARLOS A HANDAL-SACA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE STE.# 60
HIALEAH FL
33012
US

IV. Provider business mailing address

4410 W 16TH AVE STE.# 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 NumberME0072355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: