Healthcare Provider Details

I. General information

NPI: 1720212830
Provider Name (Legal Business Name): MISS MICHELLE CATHERINE SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2009
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

449 FERNDALE AVE
SOUTH SAN FRANCISCO CA
94080-1247
US

IV. Provider business mailing address

449 FERNDALE AVE
SOUTH SAN FRANCISCO CA
94080-1247
US

V. Phone/Fax

Practice location:
  • Phone: 805-340-6268
  • Fax:
Mailing address:
  • Phone: 805-340-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number11094
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: