Healthcare Provider Details

I. General information

NPI: 1477465979
Provider Name (Legal Business Name): SARA GISELE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARA BULANEK

II. Dates (important events)

Enumeration Date: 09/19/2026
Last Update Date: 09/19/2026
Certification Date: 09/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CENTRAL AVE STE F
LAKE ELSINORE CA
92530-2740
US

IV. Provider business mailing address

600 CENTRAL AVE STE F
LAKE ELSINORE CA
92530-2740
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-7575
  • Fax:
Mailing address:
  • Phone: 951-674-7575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number9939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: