Healthcare Provider Details

I. General information

NPI: 1508851692
Provider Name (Legal Business Name): SANDRA RACHEL GOTMAN D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 08/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 SW 40TH ST STE 448
MIAMI FL
33175-3598
US

IV. Provider business mailing address

8200 NW 27TH ST STE 108
DORAL FL
33122-1902
US

V. Phone/Fax

Practice location:
  • Phone: 305-229-9595
  • Fax: 305-229-9596
Mailing address:
  • Phone: 786-662-3893
  • Fax: 786-662-3899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberP0-1678
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: