Provider Demographics
NPI:1790253219
Name:PAVON SANFIEL, OSCAR ANDRES
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:ANDRES
Last Name:PAVON SANFIEL
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 1:1250 W 53RD ST APT 18
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3086
Mailing Address - Country:US
Mailing Address - Phone:305-746-1407
Mailing Address - Fax:
Practice Address - Street 1:1250 W 53RD ST APT 18
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3086
Practice Address - Country:US
Practice Address - Phone:305-746-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management