Provider Demographics
NPI:1629674379
Name:SANCHEZ, JOSE DE JESUS
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DE JESUS
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 1:3010 E VICTORIA ST
Mailing Address - Street 2:
Mailing Address - City:COMPTON
Mailing Address - State:CA
Mailing Address - Zip Code:90221-5617
Mailing Address - Country:US
Mailing Address - Phone:323-432-4399
Mailing Address - Fax:
Practice Address - Street 1:3010 E VICTORIA ST
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-5617
Practice Address - Country:US
Practice Address - Phone:323-432-4399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker