Provider Demographics
NPI:1619442985
Name:SANCHEZ, JONATHAN (CBHCM, BA)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:CBHCM, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9301 SW 92ND AVE APT C308
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2137
Mailing Address - Country:US
Mailing Address - Phone:786-683-1018
Mailing Address - Fax:305-646-0113
Practice Address - Street 1:2780 SW 37TH AVE STE 206
Practice Address - Street 2:
Practice Address - City:COCONUT GROVE
Practice Address - State:FL
Practice Address - Zip Code:33133-2740
Practice Address - Country:US
Practice Address - Phone:305-646-0112
Practice Address - Fax:305-646-0113
Is Sole Proprietor?:No
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCM101791171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator