Healthcare Provider Details

I. General information

NPI: 1770840407
Provider Name (Legal Business Name): SANDRA MARCELA WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA MARCELA FORERO M.D.

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 06/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 LAKE WORTH RD SUITE 700
LAKE WORTH FL
33467-2502
US

IV. Provider business mailing address

13643 ISHNALA CIR
WELLINGTON FL
33414-7804
US

V. Phone/Fax

Practice location:
  • Phone: 561-370-1320
  • Fax:
Mailing address:
  • Phone: 561-758-8284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberME123045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: