Healthcare Provider Details

I. General information

NPI: 1497488019
Provider Name (Legal Business Name): GARY HARO SANCHEZ MS, PPS, LEP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 07/01/2022
Certification Date: 07/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12623 AVENUE 416
OROSI CA
93647-2017
US

IV. Provider business mailing address

12623 AVENUE 416
OROSI CA
93647-2017
US

V. Phone/Fax

Practice location:
  • Phone: 559-528-4763
  • Fax: 559-528-3132
Mailing address:
  • Phone: 559-528-4763
  • Fax: 559-528-3132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberLEP2985
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: