Provider Demographics
NPI:1801974548
Name:SANCHEZ DE FUENTES AND REAL MD PA
Entity type:Organization
Organization Name:SANCHEZ DE FUENTES AND REAL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:REAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-847-6166
Mailing Address - Street 1:1170 CYPRESS GLEN CIR
Mailing Address - Street 2:HUNTER'S CREEK PROFESSIONAL PARK
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7560
Mailing Address - Country:US
Mailing Address - Phone:407-847-6166
Mailing Address - Fax:407-847-5112
Practice Address - Street 1:1170 CYPRESS GLEN CIRCLE
Practice Address - Street 2:HUNTER'S CREEK PROFESSIONAL PARK
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4998
Practice Address - Country:US
Practice Address - Phone:407-847-6166
Practice Address - Fax:407-847-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063371174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL376506700Medicaid
FLDB00330OtherRAILROAD MEDICARE
FL1174528236OtherPERSONAL NPI NUMBER
FLK351OtherMEDICARE GROUP
FLME0063371OtherSTATE MEDICAL LICENSE
FLME0063371OtherSTATE MEDICAL LICENSE
FL23929Medicare PIN
FLME0063371OtherSTATE MEDICAL LICENSE