Provider Demographics
NPI:1326027145
Name:FUENTES-SANZ, TOMAS M (PA-C)
Entity Type:Individual
Prefix:
First Name:TOMAS
Middle Name:M
Last Name:FUENTES-SANZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 848508
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33084-0508
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 MIAMI LAKES DR E
Practice Address - Street 2:OAK SQUARE BUSINESS CENTER
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2401
Practice Address - Country:US
Practice Address - Phone:305-821-9115
Practice Address - Fax:305-821-9150
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-11
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3620363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292152900Medicaid
FL292152900Medicaid
FLE6429VMedicare ID - Type Unspecified
P43009Medicare UPIN