Healthcare Provider Details

I. General information

NPI: 1760238315
Provider Name (Legal Business Name): CAMILA SANKOVICH M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 01/13/2025
Certification Date:
Deactivation Date: 12/31/2024
Reactivation Date: 01/13/2025

III. Provider practice location address

1611 NW 12 AVENUE
MIAMI FL
33136
US

IV. Provider business mailing address

1611 NW 12TH AVENUE
MIAMI FL
33136
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-1122
  • Fax:
Mailing address:
  • Phone: 305-585-6364
  • Fax: 305-325-0293

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: