Provider Demographics
NPI:1407639834
Name:SANCHEZ, ALEX OMAR
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:OMAR
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 1:2632 SE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33035-1925
Mailing Address - Country:US
Mailing Address - Phone:786-922-6168
Mailing Address - Fax:
Practice Address - Street 1:2632 SE 19TH ST
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1925
Practice Address - Country:US
Practice Address - Phone:786-922-6168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician