Provider Demographics
NPI: | 1821851130 |
---|---|
Name: | SANCHEZ, MARY JEAN (DNP, RN, ED, PHN) |
Entity Type: | Individual |
Prefix: | DR |
First Name: | MARY |
Middle Name: | JEAN |
Last Name: | SANCHEZ |
Suffix: | |
Gender: | F |
Credentials: | DNP, RN, ED, PHN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 2621 GREEN RIVER RD STE 105 #1102 |
Mailing Address - Street 2: | |
Mailing Address - City: | CORONA |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92882 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 909-721-9545 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2485 SIERRA BELLA DR |
Practice Address - Street 2: | |
Practice Address - City: | CORONA |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92882 |
Practice Address - Country: | US |
Practice Address - Phone: | 909-721-9545 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2024-01-31 |
Last Update Date: | 2024-01-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 653111 | 163W00000X, 163WG0000X, 163WH0200X, 163WA2000X, 163WC1600X, 163WS0121X, 163WX0601X, 163WH1000X, 163WI0600X, 163WP2201X, 163WX0800X, 163WX1100X |
CA | 75240 | 163WC1500X, 251K00000X, 364SC1501X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 364SC1501X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Community Health/Public Health |
No | 163W00000X | Nursing Service Providers | Registered Nurse | |
No | 163WG0000X | Nursing Service Providers | Registered Nurse | General Practice |
No | 163WH0200X | Nursing Service Providers | Registered Nurse | Home Health |
No | 163WA2000X | Nursing Service Providers | Registered Nurse | Administrator |
No | 163WC1500X | Nursing Service Providers | Registered Nurse | Community Health |
No | 163WC1600X | Nursing Service Providers | Registered Nurse | Continuing Education/Staff Development |
No | 163WS0121X | Nursing Service Providers | Registered Nurse | Plastic Surgery |
No | 163WX0601X | Nursing Service Providers | Registered Nurse | Otorhinolaryngology & Head-Neck |
No | 163WH1000X | Nursing Service Providers | Registered Nurse | Hospice |
No | 163WI0600X | Nursing Service Providers | Registered Nurse | Infection Control |
No | 163WP2201X | Nursing Service Providers | Registered Nurse | Ambulatory Care |
No | 163WX0800X | Nursing Service Providers | Registered Nurse | Orthopedic |
No | 163WX1100X | Nursing Service Providers | Registered Nurse | Ophthalmic |
No | 251K00000X | Agencies | Public Health or Welfare |