Agustin C Sanz MD PA

Key facts

NPI

1366744997

Entity type

Organization (NPI type 2)

Primary specialty

Specialist 174400000X

License

ME63215 (FL)

Legal business name

AGUSTIN C SANZ MD PA

Practice address

1420 SW Saint Lucie West Blvd
Port St Lucie, FL 34986-1709

Phone

(772) 879-4667

Fax

(772) 879-4478

NPI assigned

Dec 2, 2010

Organization subpart

No

Authorized official

Name

Carla Sanz

Title

Administrator

Phone

(772) 879-4667

National Provider Directory

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jan 6, 2011.

{
    "created_epoch": "1291248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1294272000000",
    "number": "1366744997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1420 SW SAINT LUCIE WEST BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861709",
            "telephone_number": "772-879-4667",
            "fax_number": "772-879-4478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1420 SW SAINT LUCIE WEST BLVD",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349861709",
            "telephone_number": "772-879-4667",
            "fax_number": "772-879-4478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGUSTIN C SANZ MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-02",
        "last_updated": "2011-01-06",
        "status": "A",
        "authorized_official_last_name": "SANZ",
        "authorized_official_first_name": "CARLA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "772-879-4667"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "FL",
            "license": "ME63215",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "18918",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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