Basic Information
Provider Information | |||||||||
NPI: | 1114177797 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | UNIVERSITY OF MIAMI | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | UMIAMI MEDICINE - CARDIOTHORACIC | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1611 NW 12TH AVE | ||||||||
Address2: | PO BOX 016960 (M851) | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052436837 | ||||||||
FaxNumber: | 3052438470 | ||||||||
Practice Location | |||||||||
Address1: | 1611 NW 12TH AVE | ||||||||
Address2: |   | ||||||||
City: | MIAMI | ||||||||
State: | FL | ||||||||
PostalCode: | 331361005 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3052436837 | ||||||||
FaxNumber: | 3052438470 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/19/2008 | ||||||||
LastUpdateDate: | 12/31/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SANCHEZ | ||||||||
AuthorizedOfficialFirstName: | CESIA | ||||||||
AuthorizedOfficialMiddleName: | A | ||||||||
AuthorizedOfficialTitleorPosition: | MANAGER, PROVIDER ENROLLMENT | ||||||||
AuthorizedOfficialTelephone: | 3052436837 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/31/2019 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |   |
No ID Information.