Healthcare Provider Details

I. General information

NPI: 1548846900
Provider Name (Legal Business Name): MERCEDES SANCHEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MERCY SANCHEZ

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12235 BEACH BLVD STE 110
STANTON CA
90680-3943
US

IV. Provider business mailing address

4306 BYRNE RD
RIVERSIDE CA
92509-3413
US

V. Phone/Fax

Practice location:
  • Phone: 805-691-9483
  • Fax:
Mailing address:
  • Phone: 909-233-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: