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General NPI Number Information
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NPI Number | 1942723309
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Entity Type | Individual
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Provider Name | MARIO ALBERTO SANCHEZ PUBILL SA-C
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Gender | Male
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 07/18/2017
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Provider Practice Location Address
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Address Line | 1206 GLEN AVE
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City | POMONA
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State | CA
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Zip | 91768-1212
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Country | US
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Telephone | 323-203-4769
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Fax |
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Provider Business Mailing Address
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Address Line | 10292 CENTRAL AVE APT 287
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City | MONTCLAIR
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State | CA
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Zip | 91763-3802
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Country | US
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Telephone | 323-203-4769
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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 | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | 14-555
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License Number State | CA
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