Healthcare Provider Details

I. General information

NPI: 1114182094
Provider Name (Legal Business Name): CARLOS JORGE SANCHEZ M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 3RD AVE STE J
CHULA VISTA CA
91911-5867
US

IV. Provider business mailing address

1635 3RD AVE STE J
CHULA VISTA CA
91911-5867
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-8121
  • Fax: 619-426-5950
Mailing address:
  • Phone: 619-426-8121
  • Fax: 619-426-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA22648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: