Provider Demographics
NPI:1669034435
Name:SACERIO, MARCOS
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:
Last Name:SACERIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1131
Mailing Address - Country:US
Mailing Address - Phone:786-897-1402
Mailing Address - Fax:
Practice Address - Street 1:340 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1131
Practice Address - Country:US
Practice Address - Phone:786-897-1402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL35629134374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide