Healthcare Provider Details

I. General information

NPI: 1740004167
Provider Name (Legal Business Name): ROSA ERNESTINA SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2024
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

IV. Provider business mailing address

2330 BEVERLY BLVD
LOS ANGELES CA
90057-2220
US

V. Phone/Fax

Practice location:
  • Phone: 213-798-2787
  • Fax:
Mailing address:
  • Phone: 213-798-2787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number24991
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: