Healthcare Provider Details

I. General information

NPI: 1699383422
Provider Name (Legal Business Name): ASHLEY JUNE SANCHEZ MSW INTERN, RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14140 BEACH BLVD STE 200
WESTMINSTER CA
92683-4453
US

IV. Provider business mailing address

14140 BEACH BLVD STE 200
WESTMINSTER CA
92683-4453
US

V. Phone/Fax

Practice location:
  • Phone: 714-896-7574
  • Fax: 714-896-7332
Mailing address:
  • Phone: 714-896-7574
  • Fax: 714-896-7332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: