Healthcare Provider Details

I. General information

NPI: 1679274401
Provider Name (Legal Business Name): EDWARD J SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 03/17/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2D MARDIV 2D RECONNAISSANCE BN
CAMP LEJEUNE NC
28542-0138
US

IV. Provider business mailing address

205 MIDDLERIDGE DR
HUBERT NC
28539-3897
US

V. Phone/Fax

Practice location:
  • Phone: 910-440-7703
  • Fax:
Mailing address:
  • Phone: 201-575-1721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: