Provider Demographics
NPI:1083811004
Name:SANCHEZ, MARIANO G
Entity Type:Individual
Prefix:MR
First Name:MARIANO
Middle Name:G
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 1:9314 JUANCHIDO LANE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-6832
Mailing Address - Country:US
Mailing Address - Phone:915-858-1076
Mailing Address - Fax:915-858-2367
Practice Address - Street 1:9314 JUANCHIDO LANE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-6832
Practice Address - Country:US
Practice Address - Phone:915-858-1076
Practice Address - Fax:915-858-2367
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2011-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10380101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)