Provider Demographics
NPI:1043854557
Name:SANCHEZ LUA, JERARDO ALEJANDRO
Entity Type:Individual
Prefix:
First Name:JERARDO
Middle Name:ALEJANDRO
Last Name:SANCHEZ LUA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-7667
Mailing Address - Country:US
Mailing Address - Phone:541-842-7705
Mailing Address - Fax:541-842-7640
Practice Address - Street 1:203 N PLATT AVE
Practice Address - Street 2:
Practice Address - City:EAGLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97524-8618
Practice Address - Country:US
Practice Address - Phone:541-830-6617
Practice Address - Fax:541-414-1925
Is Sole Proprietor?:No
Enumeration Date:2019-10-29
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health