Healthcare Provider Details

I. General information

NPI: 1508441957
Provider Name (Legal Business Name): DIEGO A SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

IV. Provider business mailing address

16834 FONTLEE LN
FONTANA CA
92335-5726
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-68760
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: