=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447419528
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JUAN SANCHEZ MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/04/2008
-----------------------------------------------------
Last Update Date | 11/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5340 GULF DR SUITE101
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-847-1111
-----------------------------------------------------
Fax | 727-849-3937
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5340 GULF DR SUITE101
-----------------------------------------------------
City | NEW PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34652-3950
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-847-1111
-----------------------------------------------------
Fax | 727-849-3937
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF
-----------------------------------------------------
Name | MISS RHEA JANDOC
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 727-847-1111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME0020960
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------