Provider Demographics
NPI:1750828794
Name:SANCHEZ, LELSIE C (LMT)
Entity Type:Individual
Prefix:
First Name:LELSIE
Middle Name:C
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21024 BRYANT ST APT 5
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91304-2823
Mailing Address - Country:US
Mailing Address - Phone:818-723-6495
Mailing Address - Fax:
Practice Address - Street 1:21024 BRYANT ST APT 5
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91304-2823
Practice Address - Country:US
Practice Address - Phone:818-723-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT1625210247200000X
CABT1011529405300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes405300000XOther Service ProvidersPrevention Professional
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other