Healthcare Provider Details

I. General information

NPI: 1790970788
Provider Name (Legal Business Name): NOLBERTO SANCHEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2007
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2928 DANIELS ST
MARIANNA FL
32446
US

IV. Provider business mailing address

2928 DANIELS STREET
MARIANNA FL
32446
US

V. Phone/Fax

Practice location:
  • Phone: 850-526-3555
  • Fax: 850-526-3570
Mailing address:
  • Phone: 850-526-3555
  • Fax: 850-526-3570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberACN371
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number018044
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number07-164
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME136720
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: