Provider Demographics
NPI:1639929474
Name:SANCHEZ, JEZZELL PRIME (NP)
Entity Type:Individual
Prefix:
First Name:JEZZELL PRIME
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:JEZZELL PRIME
Other - Middle Name:SALONTOY
Other - Last Name:BADANGUIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-4117
Mailing Address - Country:US
Mailing Address - Phone:626-268-7402
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-275-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-25
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028727363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner