Provider Demographics
NPI:1649577842
Name:SANCHEZ, EZEQUIEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:EZEQUIEL
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 PARK ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3537
Mailing Address - Country:US
Mailing Address - Phone:626-485-0511
Mailing Address - Fax:
Practice Address - Street 1:1414 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90001-1937
Practice Address - Country:US
Practice Address - Phone:323-588-1383
Practice Address - Fax:323-587-1668
Is Sole Proprietor?:No
Enumeration Date:2011-02-24
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20409363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant