Healthcare Provider Details

I. General information

NPI: 1922042191
Provider Name (Legal Business Name): CARLOS MATHIEU SANCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5776
US

IV. Provider business mailing address

130 HEALTH PARK BLVD
ST AUGUSTINE FL
32086-5776
US

V. Phone/Fax

Practice location:
  • Phone: 904-826-3469
  • Fax: 904-808-4608
Mailing address:
  • Phone: 904-826-3469
  • Fax: 904-808-4608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME83288
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: