MEDICARE: TOMAS M. FUENTES-SANZ PA-C

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	363A00000X	Physician Assistant	PA3620	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326027145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TOMAS M. FUENTES-SANZ PA-C

Provider Business Mailing Address
First Line	:	PO BOX 848508
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33084-0508
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5801 MIAMI LAKES DR E
Second Line	:	OAK SQUARE BUSINESS CENTER
City	:	MIAMI LAKES
State	:	FL
Zip	:	33014-2401
Country	:	US
Telephone Number	:	305-821-9115
Fax Number	:	305-821-9150

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

Provider Enumeration Date	:	01/11/2006
Last Update Date	:	04/05/2012

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Directions to “ TOMAS M. FUENTES-SANZ PA-C” Practice Location

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