MEDICARE: DR SAMUEL SANCHEZ PSC

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	207N00000X	Dermatology Physician

General Provider Information

NPI Number	:	1629278072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SAMUEL SANCHEZ PSC

Provider Business Mailing Address
First Line	:	PO BOX 6775
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-6775
Country	:	US
Telephone Number	:	787-746-3136
Fax Number	:	787-745-1585

Provider Business Practice Location Address
First Line	:	200 GRAND BOULEVARD LOS PRADOS
Second Line	:	PLAZA LOS PRADOS SUITE Z-5
City	:	CAGUAS
State	:	PR
Zip	:	00727-9507
Country	:	US
Telephone Number	:	787-746-3136
Fax Number	:	787-745-1585

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SAMUEL SANCHEZ RIVERA
Credential	:	M.D.
Telephone Number	:	787-746-3136

Provider Enumeration Date	:	07/24/2007
Last Update Date	:	07/23/2012

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