Healthcare Provider Details

I. General information

NPI: 1245151125
Provider Name (Legal Business Name): LISA SANCHEZ
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2026
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

710 HICKORY HILL LN
DES MOINES IA
50317-7856
US

V. Phone/Fax

Practice location:
  • Phone: 515-528-4379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: