Healthcare Provider Details

I. General information

NPI: 1295159176
Provider Name (Legal Business Name): WILLIAM F. SANCHEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 BASELINE RD
LA VERNE CA
91750-2353
US

IV. Provider business mailing address

233 BASELINE RD
LA VERNE CA
91750-2353
US

V. Phone/Fax

Practice location:
  • Phone: 909-833-2998
  • Fax:
Mailing address:
  • Phone: 909-833-2998
  • Fax: 909-833-2998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87526
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: