Provider Demographics
NPI:1235260746
Name:SANCHEZ, MARIO ROLANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ROLANDO
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10031 SW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-2678
Mailing Address - Country:US
Mailing Address - Phone:305-245-1520
Mailing Address - Fax:
Practice Address - Street 1:1877 FORTUNE RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-4428
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2021-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME553842080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037963804Medicaid
FLA62455Medicare UPIN