Healthcare Provider Details

I. General information

NPI: 1154291565
Provider Name (Legal Business Name): MADELINE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2025
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3480 VINE ST
RIVERSIDE CA
92507-4125
US

IV. Provider business mailing address

9555 BYHAM LN
CHERRY VALLEY CA
92223-3646
US

V. Phone/Fax

Practice location:
  • Phone: 951-363-0200
  • Fax:
Mailing address:
  • Phone: 909-835-7313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: