Provider Demographics
NPI:1558446492
Name:ALFREDO SANCHEZ FORTIS M D P A
Entity Type:Organization
Organization Name:ALFREDO SANCHEZ FORTIS M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALFREDO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANCHEZ-FORTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-621-4888
Mailing Address - Street 1:9999 NE SECOND AVENUE
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2352
Mailing Address - Country:US
Mailing Address - Phone:305-756-4400
Mailing Address - Fax:305-756-4484
Practice Address - Street 1:9999 NE SECOND AVENUE
Practice Address - Street 2:SUITE 119
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2352
Practice Address - Country:US
Practice Address - Phone:305-756-4400
Practice Address - Fax:305-756-4484
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64654174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL25435OtherBCBS
FLME64654OtherMEDICAL LICENSE NUMBER
FL25435OtherBCBS