Provider Demographics
NPI:1922816917
Name:SANCHEZ GAMBOA, ALFREDO ENRIQUE (SA)
Entity type:Individual
Prefix:MR
First Name:ALFREDO
Middle Name:ENRIQUE
Last Name:SANCHEZ GAMBOA
Suffix:
Gender:M
Credentials:SA
Other - Prefix:MR
Other - First Name:ALFREDO
Other - Middle Name:ENRIQUE
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:SA
Mailing Address - Street 1:4297 PINE RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-5041
Mailing Address - Country:US
Mailing Address - Phone:954-225-4518
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1096
Practice Address - Country:US
Practice Address - Phone:305-585-5903
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-21
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23-141246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant