Basic Information
| Provider Information | |||||||||
| NPI: | 1649296237 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANABRIA | ||||||||
| FirstName: | JUAN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911200 | ||||||||
| FaxNumber: | 3046911287 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 MEDICAL CENTER DR | ||||||||
| Address2: | SUITE 2500 | ||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013656 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911200 | ||||||||
| FaxNumber: | 3046911287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 204F00000X | 35-078993 | OH | N | Allopathic & Osteopathic Physicians | Transplant Surgery | 208600000X | 35-078993 | OH | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 27138 | WV | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 741754 | 01 | OH | BUCKEYE | OTHER | 000000221168 | 01 | OH | UNISON | OTHER | 7813237 | 01 | AETNA | OTHER | P00358847 | 01 | OH | RAILROAD MEDICARE | OTHER | 2237752 | 05 | OH | MEDICAID | 000000503723 | 01 | ANTHEM | OTHER | 363985 | 01 | OH | WELLCARE | OTHER | P00166556 | 01 | OH | RAILROAD MEDICARE | OTHER |