MEDICARE: MRS. MARA RIVERA SANCHEZ PHYSICIAN ASSISTANT

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	363AM0700X	Medical Physician Assistant	PA 9103068	FL

General Provider Information

NPI Number	:	1902858673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARA RIVERA SANCHEZ PHYSICIAN ASSISTANT

Provider Business Mailing Address
First Line	:	6517 TAFT ST
Second Line	:	SUITE 101
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4048
Country	:	US
Telephone Number	:	954-983-9191
Fax Number	:	954-983-1152

Provider Business Practice Location Address
First Line	:	6517 TAFT ST
Second Line	:	SUITE 101
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-4048
Country	:	US
Telephone Number	:	954-983-9191
Fax Number	:	954-983-1152

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	02/12/2016

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