Healthcare Provider Details

I. General information

NPI: 1245620368
Provider Name (Legal Business Name): ANGELA SANCHEZ CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2015
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 ADELANTO AVE
ST AUGUSTINE FL
32092
US

IV. Provider business mailing address

52 TUSCAN WAY STE 202-213
ST AUGUSTINE FL
32092-1850
US

V. Phone/Fax

Practice location:
  • Phone: 310-294-0131
  • Fax:
Mailing address:
  • Phone: 310-294-0131
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number154944
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: