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General NPI Number Information
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NPI Number | 1508421439
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Entity Type | Individual
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Provider Name | MRS. SANDRA FERRAZ MARIMOTO I
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Gender | Female
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 5481 N UNIVERSITY DR
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City | CORAL SPRINGS
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State | FL
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Zip | 33067-4643
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Country | US
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Telephone | 954-577-5548
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Fax |
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Provider Business Mailing Address
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Address Line | 489 FISHTAIL TER
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City | WESTON
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State | FL
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Zip | 33327-2477
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Country | US
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Telephone | 954-638-7202
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 26260
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License Number State | FL
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