Provider Demographics
NPI:1134248941
Name:MINTZ, SANFORD B (PHD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:B
Last Name:MINTZ
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ALMINAR AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146
Mailing Address - Country:US
Mailing Address - Phone:305-431-8014
Mailing Address - Fax:305-663-4212
Practice Address - Street 1:SANFORD MINTZ PHD 53423 AVENIDA DIAZ
Practice Address - Street 2:LA QUINTA
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92253
Practice Address - Country:US
Practice Address - Phone:305-663-0010
Practice Address - Fax:305-663-4212
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3171103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75459OtherBLUE CROSS / BLUE SHIELD
75459Medicare ID - Type Unspecified