Healthcare Provider Details

I. General information

NPI: 1861969271
Provider Name (Legal Business Name): JOSE A SANCHEZ IDMT-PARAMEDIC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2018
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 PITSENBARGER BLVD
JOINT BASE LEWIS MCCHORD WA
98438-1201
US

IV. Provider business mailing address

4262 DUDLEY DR NE
LACEY WA
98516-5604
US

V. Phone/Fax

Practice location:
  • Phone: 603-381-1124
  • Fax:
Mailing address:
  • Phone: 360-338-1124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code146L00000X
TaxonomyParamedic
License NumberM5098459
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1710I1003X
TaxonomyIndependent Duty Medical Technicians
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: