Provider Demographics
NPI:1619267036
Name:SANCHEZ, BRANDON XAVIER LEE
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:XAVIER LEE
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 1:327 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCEDES
Mailing Address - State:TX
Mailing Address - Zip Code:78570-3105
Mailing Address - Country:US
Mailing Address - Phone:956-565-9300
Mailing Address - Fax:956-565-9686
Practice Address - Street 1:327 W 3RD ST
Practice Address - Street 2:
Practice Address - City:MERCEDES
Practice Address - State:TX
Practice Address - Zip Code:78570-3105
Practice Address - Country:US
Practice Address - Phone:956-565-9300
Practice Address - Fax:956-565-9686
Is Sole Proprietor?:No
Enumeration Date:2011-04-19
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210778224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX184911901Medicaid
TX184911901Medicaid