Healthcare Provider Details

I. General information

NPI: 1861396632
Provider Name (Legal Business Name): BLANCA IRIS SANCHEZ ROSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SNAKE RIVER DR. B1
ALPINE WY
83128
US

IV. Provider business mailing address

PO BOX 12962
JACKSON WY
83002-2962
US

V. Phone/Fax

Practice location:
  • Phone: 307-699-5584
  • Fax:
Mailing address:
  • Phone: 307-699-5584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: