Healthcare Provider Details

I. General information

NPI: 1568377141
Provider Name (Legal Business Name): ELIZABETH STACEY SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 SAN RAMON DR
FULLERTON CA
92835-1238
US

IV. Provider business mailing address

23595 CAMPBELLTON RD
SAN ANTONIO TX
78264-4613
US

V. Phone/Fax

Practice location:
  • Phone: 210-668-9444
  • Fax:
Mailing address:
  • Phone: 210-668-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: