Healthcare Provider Details

I. General information

NPI: 1801639133
Provider Name (Legal Business Name): NELSON SANCHEZ FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W CENTER ST
MANTECA CA
95337-7300
US

IV. Provider business mailing address

500 W HOSPITAL RD
FRENCH CAMP CA
95231-9693
US

V. Phone/Fax

Practice location:
  • Phone: 209-239-9600
  • Fax:
Mailing address:
  • Phone: 209-468-6000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029771
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: