Provider Demographics
NPI:1235470253
Name:SANDINO GONZALEZ, MD
Entity Type:Organization
Organization Name:SANDINO GONZALEZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDINO
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-274-9890
Mailing Address - Street 1:6150 SUNSET DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5040
Mailing Address - Country:US
Mailing Address - Phone:305-274-9890
Mailing Address - Fax:305-274-8791
Practice Address - Street 1:6150 SUNSET DRIVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143
Practice Address - Country:US
Practice Address - Phone:305-274-9890
Practice Address - Fax:305-274-8791
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GONZALEZ & PEREZ M.D,P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-15
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75564332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG64087Medicare UPIN