Provider Demographics
NPI:1790970788
Name:SANCHEZ, NOLBERTO (MD)
Entity Type:Individual
Prefix:
First Name:NOLBERTO
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 DANIELS STREET
Mailing Address - Street 2:
Mailing Address - City:MARIANNA
Mailing Address - State:FL
Mailing Address - Zip Code:32446
Mailing Address - Country:US
Mailing Address - Phone:850-526-3555
Mailing Address - Fax:850-526-3570
Practice Address - Street 1:2928 DANIELS ST
Practice Address - Street 2:
Practice Address - City:MARIANNA
Practice Address - State:FL
Practice Address - Zip Code:32446
Practice Address - Country:US
Practice Address - Phone:850-526-3555
Practice Address - Fax:850-526-3570
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN371208D00000X
PR018044208D00000X
TX07-164246ZS0410X
FLME136720208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLN0574OtherMEDICARE PIN
FL004637000Medicaid