Healthcare Provider Details

I. General information

NPI: 1215852249
Provider Name (Legal Business Name): LAUREN SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W COVINA BLVD
SAN DIMAS CA
91773-3205
US

IV. Provider business mailing address

1128 S CORONADO AVE
WEST COVINA CA
91790-5305
US

V. Phone/Fax

Practice location:
  • Phone: 909-675-7017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number41587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: