Healthcare Provider Details

I. General information

NPI: 1750104436
Provider Name (Legal Business Name): NESTORJSANCHEZPSYCHOTHERAPIST,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2024
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 TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: NESTOR JAVIER SANCHEZ
Title or Position: CEO/OWNER
Credential: M.S., LMFT
Phone: 323-842-7665