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General NPI Number Information
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NPI Number | 1356738595
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Entity Type | Organization
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Legal Business Name | SYDEA ENTERPRISES INC.
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Dates
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Enumeration Date | 04/24/2015
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Last Update Date | 04/24/2015
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Provider Practice Location Address
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Address Line | 20311 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1778
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Country | US
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Telephone | 949-274-7104
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Fax |
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Provider Business Mailing Address
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Address Line | 20311 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-1778
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Country | US
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Telephone | 949-274-7104
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. VENICE SANCHEZ
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Credential |
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Telephone | 949-274-7104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 115232
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License Number State | CA
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