Provider Demographics
NPI:1255164422
Name:RICHIEZ, SANDER
Entity type:Individual
Prefix:
First Name:SANDER
Middle Name:
Last Name:RICHIEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2253 NW 208TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-2321
Mailing Address - Country:US
Mailing Address - Phone:305-807-8807
Mailing Address - Fax:754-732-8089
Practice Address - Street 1:2253 NW 208TH TER
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-2321
Practice Address - Country:US
Practice Address - Phone:305-807-8807
Practice Address - Fax:754-732-8089
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-23
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor