Provider Demographics
NPI:1295718245
Name:SARMIENTO, CESAR FERNANDEZ (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:FERNANDEZ
Last Name:SARMIENTO
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:P.O. BOX 490570
Mailing Address - Street 2:313 SOUTH SECOND ST
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0570
Mailing Address - Country:US
Mailing Address - Phone:352-787-7850
Mailing Address - Fax:352-728-3774
Practice Address - Street 1:313 SOUTH SECOND ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748
Practice Address - Country:US
Practice Address - Phone:352-787-7850
Practice Address - Fax:352-787-3774
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31278207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL02122OtherBCBSFL
FL02122OtherBCBSFL
02122Medicare PIN