Healthcare Provider Details

I. General information

NPI: 1679043855
Provider Name (Legal Business Name): BRANDON SANCHEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 11/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6894 ALAMO DOWNS PKWY
SAN ANTONIO TX
78238-4535
US

IV. Provider business mailing address

6894 ALAMO DOWNS PKWY
SAN ANTONIO TX
78238-4535
US

V. Phone/Fax

Practice location:
  • Phone: 210-767-8004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: