Provider Demographics
NPI:1790084762
Name:SANCHEZ, TANI DIANCA
Entity Type:Individual
Prefix:
First Name:TANI
Middle Name:DIANCA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6871 W BRIGHTWATER WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-6905
Mailing Address - Country:US
Mailing Address - Phone:520-395-1545
Mailing Address - Fax:
Practice Address - Street 1:6871 W BRIGHTWATER WAY
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85757-6905
Practice Address - Country:US
Practice Address - Phone:520-395-1545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2725337385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child