Provider Demographics
NPI:1114576451
Name:SANCHEZ, CELIANNA ESMERALDA
Entity Type:Individual
Prefix:
First Name:CELIANNA
Middle Name:ESMERALDA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 CHAPPARAL CT
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-1204
Mailing Address - Country:US
Mailing Address - Phone:510-375-9856
Mailing Address - Fax:
Practice Address - Street 1:2640 CHAPPARAL CT
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-1204
Practice Address - Country:US
Practice Address - Phone:510-375-9856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician