Provider Demographics
NPI:1467722785
Name:SANCHEZ, BEVERLY (BA)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MRS
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5628 E SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:CA
Mailing Address - Zip Code:90040-2922
Mailing Address - Country:US
Mailing Address - Phone:323-318-9960
Mailing Address - Fax:
Practice Address - Street 1:5628 E SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-2922
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:323-780-3211
Is Sole Proprietor?:No
Enumeration Date:2012-01-03
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDICAL