Healthcare Provider Details

I. General information

NPI: 1245523414
Provider Name (Legal Business Name): SANCHEZ DERMATOLOGY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 N PLANT AVE
PLANT CITY FL
33563-7248
US

IV. Provider business mailing address

301 W PLATT ST #186
TAMPA FL
33606-2292
US

V. Phone/Fax

Practice location:
  • Phone: 813-839-3376
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME102887
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License NumberME102887
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME102887
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME102887
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License NumberME102887
License Number StateFL
# 6
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME102887
License Number StateFL

VIII. Authorized Official

Name: FITZGERALDO A SANCHEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 813-830-3376