Healthcare Provider Details

I. General information

NPI: 1962208413
Provider Name (Legal Business Name): ORLANDO RAY SANCHEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 02/24/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31599 W PARK RD LOT 23
SUTHERLAND NE
69165-2121
US

IV. Provider business mailing address

11011 Q ST STE 101C
OMAHA NE
68137-3700
US

V. Phone/Fax

Practice location:
  • Phone: 308-539-4343
  • Fax:
Mailing address:
  • Phone: 402-697-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: