Provider Demographics
NPI:1114796323
Name:SANABRIA, KETTY
Entity Type:Individual
Prefix:
First Name:KETTY
Middle Name:
Last Name:SANABRIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14472 SW 285TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-1620
Mailing Address - Country:US
Mailing Address - Phone:786-328-4936
Mailing Address - Fax:
Practice Address - Street 1:3251 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3285
Practice Address - Country:US
Practice Address - Phone:305-888-3364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-28
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL66713183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist