Healthcare Provider Details

I. General information

NPI: 1629540331
Provider Name (Legal Business Name): MR. JAVIER SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2018
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S MARION ST OFC 316
OAK PARK IL
60302-2809
US

IV. Provider business mailing address

5206 N LIND AVE
CHICAGO IL
60630-1436
US

V. Phone/Fax

Practice location:
  • Phone: 708-383-7500
  • Fax: 708-383-2842
Mailing address:
  • Phone: 224-707-0742
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: