Provider Demographics
NPI:1902841661
Name:SANZ, AGUSTIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:AGUSTIN
Middle Name:C
Last Name:SANZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AGUSTIN
Other - Middle Name:C
Other - Last Name:SANZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:293 NW PEACOCK BLVD STE 101-104
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2222
Mailing Address - Country:US
Mailing Address - Phone:772-335-9600
Mailing Address - Fax:772-879-4478
Practice Address - Street 1:293 NW PEACOCK BLVD STE 101-104
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-2222
Practice Address - Country:US
Practice Address - Phone:772-335-9600
Practice Address - Fax:772-879-4478
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63215207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18918Medicaid
FL18918Medicaid
FL18918YMedicare PIN