Healthcare Provider Details

I. General information

NPI: 1952523250
Provider Name (Legal Business Name): MAYRA SANCHEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/29/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 CAMPUS POINT DR
SAN DIEGO CA
92121-1518
US

IV. Provider business mailing address

10010 CAMPUS POINT DR # DR305
SAN DIEGO CA
92121-1518
US

V. Phone/Fax

Practice location:
  • Phone: 858-678-6538
  • Fax: 858-678-6538
Mailing address:
  • Phone: 858-678-6538
  • Fax: 858-678-6571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA117644
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number946569
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: