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General NPI Number Information
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NPI Number | 1801463484
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Entity Type | Individual
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Provider Name | KENNETE JUAN SANCHEZ
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Gender | Male
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Dates
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Enumeration Date | 06/10/2021
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 7613 S JORDAN LANDING BLVD STE 200
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City | WEST JORDAN
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State | UT
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Zip | 84084-1973
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Country | US
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Telephone | 801-613-9843
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Fax | 385-213-6087
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Provider Business Mailing Address
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Address Line | 4943 S RAYFORD CIR
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City | KEARNS
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State | UT
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Zip | 84118-7226
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Country | US
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Telephone | 801-814-2262
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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 | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 1492
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License Number State | UT
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