Healthcare Provider Details

I. General information

NPI: 1972413466
Provider Name (Legal Business Name): JASMINE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 W REDLANDS BLVD
REDLANDS CA
92373-4641
US

IV. Provider business mailing address

10977 PERSIMMON LN
FONTANA CA
92337-6892
US

V. Phone/Fax

Practice location:
  • Phone: 909-783-1111
  • Fax:
Mailing address:
  • Phone: 909-510-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number28914
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: