Healthcare Provider Details

I. General information

NPI: 1316445984
Provider Name (Legal Business Name): HUMANOS SALUS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E 17TH ST STE E214
SANTA ANA CA
92701-2219
US

IV. Provider business mailing address

1125 E 17TH ST STE E214
SANTA ANA CA
92701-2219
US

V. Phone/Fax

Practice location:
  • Phone: 714-955-4776
  • Fax:
Mailing address:
  • Phone: 714-955-4776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number00350615
License Number StateCA

VIII. Authorized Official

Name: DAVID A SANCHEZ
Title or Position: DIRECTOR
Credential: MD
Phone: 714-473-7555