Healthcare Provider Details

I. General information

NPI: 1023939477
Provider Name (Legal Business Name): SERGIO SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S GLENDORA AVE UNIT 2318
WEST COVINA CA
91790-5925
US

IV. Provider business mailing address

301 S GLENDORA AVE UNIT 2318
WEST COVINA CA
91790-5925
US

V. Phone/Fax

Practice location:
  • Phone: 956-562-5245
  • Fax:
Mailing address:
  • Phone: 956-562-5245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: