Basic Information
| Provider Information | |||||||||
| NPI: | 1134164395 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | CARLOS | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619674118 | ||||||||
| FaxNumber: | 5619673463 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 204 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5619674118 | ||||||||
| FaxNumber: | 5619673463 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2006 | ||||||||
| LastUpdateDate: | 01/18/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/18/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | ME75641 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 254589600 | 05 | FL | MEDICAID | KW619 | 01 | FL | MEDICARE PIN | OTHER |