Healthcare Provider Details

I. General information

NPI: 1184736407
Provider Name (Legal Business Name): DR. BARDOMIANO SANCHEZ JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: BARDO SANCHEZ MD

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

15409 N FIRCREST CIR
SPOKANE WA
99208-8243
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-6336
  • Fax: 509-252-6337
Mailing address:
  • Phone: 509-466-6158
  • Fax: 509-466-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00035747
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: