Provider Demographics
NPI:1508421439
Name:MARIMOTO, SANDRA FERRAZ I
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:FERRAZ
Last Name:MARIMOTO
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 SABAL TRL
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33327-1639
Mailing Address - Country:US
Mailing Address - Phone:954-638-7202
Mailing Address - Fax:
Practice Address - Street 1:5481 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-4643
Practice Address - Country:US
Practice Address - Phone:954-577-5548
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-06
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL262601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice