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General NPI Number Information
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NPI Number | 1194434811
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Entity Type | Individual
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Provider Name | ROBERTO IVAN SANCHEZ NERI NP
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Gender | Male
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Dates
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Enumeration Date | 11/21/2022
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 6021 PACIFIC BLVD STE 103
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City | HUNTINGTON PARK
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State | CA
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Zip | 90255-2953
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Country | US
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Telephone | 323-300-6211
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Fax |
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Provider Business Mailing Address
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Address Line | 2009 N INDIANA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90032-3616
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Country | US
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Telephone | 323-633-5944
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95023383
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License Number State | CA
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