Provider Demographics
NPI:1568551893
Name:CARLOS J. SANCHEZ M.D.
Entity Type:Organization
Organization Name:CARLOS J. SANCHEZ M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHANNES
Authorized Official - Middle Name:
Authorized Official - Last Name:LASTHAUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-426-8121
Mailing Address - Street 1:1635 3RD AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-5882
Mailing Address - Country:US
Mailing Address - Phone:619-426-8121
Mailing Address - Fax:619-426-5950
Practice Address - Street 1:1635 3RD AVE
Practice Address - Street 2:SUITE J
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-5882
Practice Address - Country:US
Practice Address - Phone:619-426-8121
Practice Address - Fax:619-426-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22648208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A23191Medicare UPIN