MEDICARE: MR. EZEQUIEL SANCHEZ PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA20409	CA

General Provider Information

NPI Number	:	1649577842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. EZEQUIEL SANCHEZ PA-C

Provider Business Mailing Address
First Line	:	2211 PARK ROSE AVE
Second Line	:
City	:	DUARTE
State	:	CA
Zip	:	91010-3537
Country	:	US
Telephone Number	:	626-485-0511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1414 E FLORENCE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90001-1937
Country	:	US
Telephone Number	:	323-588-1383
Fax Number	:	323-587-1668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/24/2011
Last Update Date	:	05/01/2015

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