Healthcare Provider Details

I. General information

NPI: 1649619800
Provider Name (Legal Business Name): MADELINE SANCHEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4370 EVE RD
SIMI VALLEY CA
93063-2323
US

IV. Provider business mailing address

1040 FLYNN RD
CAMARILLO CA
93012-5092
US

V. Phone/Fax

Practice location:
  • Phone: 805-915-4400
  • Fax: 805-915-4401
Mailing address:
  • Phone: 805-659-1740
  • Fax: 805-659-3217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number142352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: