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General NPI Number Information
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NPI Number | 1225692692
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Entity Type | Individual
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Provider Name | ALVARO SUTACHAN SANCHEZ
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Gender | Male
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 400 N PEPPER AVE
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City | COLTON
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State | CA
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Zip | 92324-1801
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Country | US
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Telephone | 909-580-3390
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Fax |
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Provider Business Mailing Address
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Address Line | 341 MAGNOLIA AVE STE 101
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City | CORONA
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State | CA
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Zip | 92879-3330
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Country | US
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Telephone | 951-256-8150
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Fax | 951-256-8151
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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