Healthcare Provider Details

I. General information

NPI: 1629753827
Provider Name (Legal Business Name): MARTIN SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W EL SEGUNDO BLVD
HAWTHORNE CA
90250-3317
US

IV. Provider business mailing address

1608 E PINE ST
COMPTON CA
90221-1349
US

V. Phone/Fax

Practice location:
  • Phone: 323-754-2816
  • Fax:
Mailing address:
  • Phone: 424-232-1147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-CHQNZP
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: