Healthcare Provider Details

I. General information

NPI: 1649577842
Provider Name (Legal Business Name): EZEQUIEL SANCHEZ PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2011
Last Update Date: 05/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 E FLORENCE AVE
LOS ANGELES CA
90001-1937
US

IV. Provider business mailing address

2211 PARK ROSE AVE
DUARTE CA
91010-3537
US

V. Phone/Fax

Practice location:
  • Phone: 323-588-1383
  • Fax: 323-587-1668
Mailing address:
  • Phone: 626-485-0511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: