Healthcare Provider Details

I. General information

NPI: 1639451669
Provider Name (Legal Business Name): MISS CARLY LOUISE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 04/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 W AVENUE J SUITE C
LANCASTER CA
93534-3443
US

IV. Provider business mailing address

2740 FAIRFIELD AVE
PALMDALE CA
93550-4441
US

V. Phone/Fax

Practice location:
  • Phone: 661-949-0131
  • Fax: 661-729-8912
Mailing address:
  • Phone: 661-236-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: