Provider Demographics
NPI:1891793337
Name:HANDAL-SACA, CARLOS A (MD)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:HANDAL-SACA
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 1:4410 W 16TH AVE
Mailing Address - Street 2:STE.# 60
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-7194
Mailing Address - Country:US
Mailing Address - Phone:305-823-0721
Mailing Address - Fax:305-823-2041
Practice Address - Street 1:4410 W 16TH AVE
Practice Address - Street 2:STE.# 60
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012
Practice Address - Country:US
Practice Address - Phone:305-823-0721
Practice Address - Fax:305-823-2041
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0072355208000000X
FLME72355207PP0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL160089OtherSTAY WELL PROVIDER #
FL172504OtherJMH PLAN
FL0025955OtherNHP PROVIDER #
FL107395OtherHUMANA PROVIDER #
FL107396OtherHUMANA PROVIDER #
FL270390OtherAVMED PROVIDER NUMBER
FL592170298OtherUNITED HEALTHCARE PROVIDE
FLSG004535-F794OtherVISTA HEALTH PLAN PROVIDE
FL12-003353OtherUNITED HEALTHCARE PROVIDE
FL259672500Medicaid
FL592170298OtherTID
FL7303212OtherAETNA PROVIDER #
FL172497OtherJMH PLAN
FL213316OtherAMERIGROUP PROVIDER #
FL9441840001OtherCIGNA PAL ID
FL259672501Medicaid
FL44267OtherBC/BS PROVIDER #