MEDICARE: JOSE SANCHEZ

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	252Y00000X	Early Intervention Provider Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	611854576	OTHER	FL	TAX ID

General Provider Information

NPI Number	:	1891214607
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSE SANCHEZ

Provider Business Mailing Address
First Line	:	1036 QUAIL AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-3249
Country	:	US
Telephone Number	:	305-321-5578
Fax Number	:

Provider Business Practice Location Address
First Line	:	1036 QUAIL AVE
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166
Country	:	US
Telephone Number	:	305-321-5578
Fax Number	:

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

Provider Enumeration Date	:	09/12/2017
Last Update Date	:	07/21/2022

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Directions to “ JOSE SANCHEZ ” Practice Location

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