Provider Demographics
NPI:1114527884
Name:SANCHEZ, LEE RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:RODRIGUEZ
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 1:2200 W WADLEY AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-6405
Mailing Address - Country:US
Mailing Address - Phone:432-218-8640
Mailing Address - Fax:
Practice Address - Street 1:2200 W WADLEY AVE STE 10
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79705-6405
Practice Address - Country:US
Practice Address - Phone:432-218-8640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-30
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018041363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner