Healthcare Provider Details

I. General information

NPI: 1376462382
Provider Name (Legal Business Name): CORY JACOB SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 N PALM AVE STE 103
ONTARIO CA
91762-3215
US

IV. Provider business mailing address

5235 RENOIR LN
CHINO HILLS CA
91709-4676
US

V. Phone/Fax

Practice location:
  • Phone: 909-657-9164
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: