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General NPI Number Information
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NPI Number | 1104547272
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Entity Type | Individual
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Provider Name | MARISOL HERNANDEZ-SANCHEZ OD
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Gender | Female
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 12263 HIGHLAND AVE STE 120
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-2576
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Country | US
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Telephone | 909-899-5001
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Fax |
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Provider Business Mailing Address
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Address Line | 5318 DURFEE AVE
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City | EL MONTE
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State | CA
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Zip | 91732-1222
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Country | US
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Telephone | 626-587-6532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 35278
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License Number State | CA
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