Provider Demographics
NPI:1083754451
Name:SANCHEZ, LARRY ANTHONY (SOCIAL WORKER II)
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:ANTHONY
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:SOCIAL WORKER II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2743 S MILDRED PL
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7015
Mailing Address - Country:US
Mailing Address - Phone:909-579-8113
Mailing Address - Fax:909-579-8149
Practice Address - Street 1:934 N MOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-3659
Practice Address - Country:US
Practice Address - Phone:909-579-8100
Practice Address - Fax:909-579-8149
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAUNLICENSED104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker