=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750104436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NESTORJSANCHEZPSYCHOTHERAPIST,INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2024
-----------------------------------------------------
Last Update Date | 11/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4193 FLAT ROCK DR STE 200
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92505-7113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-546-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4193 FLAT ROCK DR STE 200
-----------------------------------------------------
City | RIVERSIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92505-7113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-546-0012
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO/OWNER
-----------------------------------------------------
Name | NESTOR JAVIER SANCHEZ
-----------------------------------------------------
Credential | M.S., LMFT
-----------------------------------------------------
Telephone | 323-842-7665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------