Individual
OMAR PASTOR SANGUEZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7595
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7595
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
200000967
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006600531
—
VA
05
—
006607080
—
VA
05
—
89126MP
—
NC
05
—
G40302
—
SC
Enumeration date
12/15/2005
Last updated
09/23/2010
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