Healthcare Provider Details

I. General information

NPI: 1255194254
Provider Name (Legal Business Name): NICOLE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 E PALMDALE BLVD STE 211
PALMDALE CA
93550-4750
US

IV. Provider business mailing address

1050 E PALMDALE BLVD STE 211
PALMDALE CA
93550-4750
US

V. Phone/Fax

Practice location:
  • Phone: 661-208-4699
  • Fax: 661-208-4761
Mailing address:
  • Phone: 661-208-4699
  • Fax: 661-208-4761

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: