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General NPI Number Information
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NPI Number | 1942430202
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Entity Type | Organization
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Legal Business Name | SANCHEZ PRIME CARE PC
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Dates
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Enumeration Date | 07/21/2009
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Last Update Date | 08/11/2009
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Provider Practice Location Address
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Address Line | 326 N WESTERN AVE STE 270
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City | LOS ANGELES
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State | CA
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Zip | 90004-2602
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Country | US
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Telephone | 631-897-5762
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Fax |
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Provider Business Mailing Address
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Address Line | 326 N WESTERN AVE STE 270
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City | LOS ANGELES
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State | CA
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Zip | 90004-2602
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Country | US
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Telephone | 631-897-5762
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAREQ ALI
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Credential | M.D.
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Telephone | 631-897-5762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A51048
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License Number State | CA
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