Provider Demographics
NPI:1124194311
Name:HANDAL SACA PEDIATRICS M.D. P.A.
Entity Type:Organization
Organization Name:HANDAL SACA PEDIATRICS M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLOS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HANDAL SACA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-823-0721
Mailing Address - Street 1:4410 W 16TH AVE
Mailing Address - Street 2:SUITE # 60
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7194
Mailing Address - Country:US
Mailing Address - Phone:305-823-0721
Mailing Address - Fax:305-823-2041
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:SUITE # 60
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-7194
Practice Address - Country:US
Practice Address - Phone:305-823-0721
Practice Address - Fax:305-823-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME-0072355208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259672500Medicaid