Healthcare Provider Details

I. General information

NPI: 1114151727
Provider Name (Legal Business Name): NESTOR JAVIER SANCHEZ M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2009
Last Update Date: 11/01/2024
Certification Date: 11/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4193 FLAT ROCK DR STE 200
RIVERSIDE CA
92505-7113
US

IV. Provider business mailing address

4193 FLAT ROCK DR STE 200
RIVERSIDE CA
92505-7113
US

V. Phone/Fax

Practice location:
  • Phone: 951-546-0012
  • Fax:
Mailing address:
  • Phone: 951-546-0012
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number114122
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: