Provider Demographics
NPI:1083219174
Name:SANCHEZ, ULYSSES
Entity Type:Individual
Prefix:
First Name:ULYSSES
Middle Name:
Last Name:SANCHEZ
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:PO BOX 1538
Mailing Address - Street 2:
Mailing Address - City:LEBEC
Mailing Address - State:CA
Mailing Address - Zip Code:93243-1538
Mailing Address - Country:US
Mailing Address - Phone:818-987-7675
Mailing Address - Fax:
Practice Address - Street 1:28100 BOUQUET CANYON RD STE 206 1/2
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-2014
Practice Address - Country:US
Practice Address - Phone:818-987-7675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA72056225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty