Healthcare Provider Details

I. General information

NPI: 1396350658
Provider Name (Legal Business Name): HUMBERTO SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date: 01/04/2024
Reactivation Date: 03/26/2024

III. Provider practice location address

39420 LIBERTY ST STE 150
FREMONT CA
94538-2284
US

IV. Provider business mailing address

PO BOX 399318
SAN FRANCISCO CA
94139-9318
US

V. Phone/Fax

Practice location:
  • Phone: 510-794-5155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-55288
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: