Provider Demographics
NPI:1578636833
Name:SANCHEZ, PEDRO A (DO)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:A
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 SR 7 STE 215
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449
Mailing Address - Country:US
Mailing Address - Phone:561-791-1630
Mailing Address - Fax:561-791-0595
Practice Address - Street 1:3319 SR 7 STE 215
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449
Practice Address - Country:US
Practice Address - Phone:561-791-1630
Practice Address - Fax:561-791-0595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005893207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374513900Medicaid
FL374513900Medicaid