Provider Demographics
NPI:1467213769
Name:SANCHEZ, KIARALIS
Entity Type:Individual
Prefix:
First Name:KIARALIS
Middle Name:
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 1:148 CALLE PROGRESO
Mailing Address - Street 2:
Mailing Address - City:AGUADILLA
Mailing Address - State:PR
Mailing Address - Zip Code:00603-4814
Mailing Address - Country:US
Mailing Address - Phone:787-560-0776
Mailing Address - Fax:
Practice Address - Street 1:148 CALLE PROGRESO
Practice Address - Street 2:
Practice Address - City:AGUADILLA
Practice Address - State:PR
Practice Address - Zip Code:00603-4814
Practice Address - Country:US
Practice Address - Phone:787-560-0776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-23
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR6137468174H00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth Educator