Provider Demographics
NPI:1154480218
Name:SANCHEZ, RAFAEL (PA)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:941 N KROME AVE
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4408
Mailing Address - Country:US
Mailing Address - Phone:305-248-6311
Mailing Address - Fax:305-242-5559
Practice Address - Street 1:941 N KROME AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4408
Practice Address - Country:US
Practice Address - Phone:305-248-6311
Practice Address - Fax:305-242-5559
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101549363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPA9101549OtherLICENSE
E7713AMedicare PIN
FLP62677Medicare UPIN