Provider Demographics
NPI:1780648113
Name:SANCHEZ HUMALA, NORMA BERNARDINA (MD)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:BERNARDINA
Last Name:SANCHEZ HUMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NORMA
Other - Middle Name:BERNARDINA
Other - Last Name:SANCHEZ-HERRERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5340 GULF DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3950
Mailing Address - Country:US
Mailing Address - Phone:727-845-7005
Mailing Address - Fax:727-845-7047
Practice Address - Street 1:5340 GULF DR
Practice Address - Street 2:SUITE 102
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3950
Practice Address - Country:US
Practice Address - Phone:727-845-7005
Practice Address - Fax:727-845-7047
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86422207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267527700Medicaid
FLH47529Medicare UPIN
FL57778Medicare ID - Type Unspecified