Provider Demographics
NPI:1336515634
Name:SANCHEZ, MARISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 IMPERIAL HWY
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1040
Mailing Address - Country:US
Mailing Address - Phone:714-681-9070
Mailing Address - Fax:
Practice Address - Street 1:385 IMPERIAL HWY
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-1040
Practice Address - Country:US
Practice Address - Phone:714-681-9070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20-3257211103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19509Medicare PIN