MEDICARE: MR. MANUEL SARRIA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW7324	FL

General Provider Information

NPI Number	:	1114060019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MANUEL SARRIA

Provider Business Mailing Address
First Line	:	15122 NW 87TH CT
Second Line	:
City	:	MIAMI LAKES
State	:	FL
Zip	:	33018-1387
Country	:	US
Telephone Number	:	305-231-5476
Fax Number	:

Provider Business Practice Location Address
First Line	:	4175 W 20TH AVE
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5874
Country	:	US
Telephone Number	:	305-825-0300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	07/08/2007

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