Provider Demographics
NPI:1235899055
Name:SANCHEZ, MARISA CHAIDEZ (NP)
Entity Type:Individual
Prefix:
First Name:MARISA
Middle Name:CHAIDEZ
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79440 CORPORATE CENTER DR STE 119
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-7244
Mailing Address - Country:US
Mailing Address - Phone:442-324-0561
Mailing Address - Fax:
Practice Address - Street 1:79440 CORPORATE CENTER DR STE 119
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-7244
Practice Address - Country:US
Practice Address - Phone:442-324-0561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-20
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017092363LP2300X, 363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily