Provider Demographics
NPI:1902858673
Name:SANCHEZ, MARA RIVERA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MRS
First Name:MARA
Middle Name:RIVERA
Last Name:SANCHEZ
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Gender:F
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:6517 TAFT ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4048
Mailing Address - Country:US
Mailing Address - Phone:954-983-9191
Mailing Address - Fax:954-983-1152
Practice Address - Street 1:6517 TAFT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4048
Practice Address - Country:US
Practice Address - Phone:954-983-9191
Practice Address - Fax:954-983-1152
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-02-12
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Provider Licenses
StateLicense IDTaxonomies
FLPA 9103068363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical