Provider Demographics
NPI:1679939383
Name:SANCHEZ, JORGE PULIDO (CADDESO411260827)
Entity Type:Individual
Prefix:MR
First Name:JORGE
Middle Name:PULIDO
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:CADDESO411260827
Other - Prefix:MR
Other - First Name:JORGE
Other - Middle Name:PULIDO
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:210 STANFORD ST
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3268
Mailing Address - Country:US
Mailing Address - Phone:831-840-3060
Mailing Address - Fax:831-423-6657
Practice Address - Street 1:125 RIGG ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4203
Practice Address - Country:US
Practice Address - Phone:831-423-3890
Practice Address - Fax:831-423-6657
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-11
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACADDESO411260827101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10OtherMEDICAL