Provider Demographics
NPI:1841782612
Name:SANCHEZ, ELISE MANUELA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELISE
Middle Name:MANUELA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ELISE
Other - Middle Name:MANUELA
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:801 CORPORATE CENTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2639
Mailing Address - Country:US
Mailing Address - Phone:909-802-1362
Mailing Address - Fax:909-622-6810
Practice Address - Street 1:801 CORPORATE CENTER DR STE 100
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2639
Practice Address - Country:US
Practice Address - Phone:213-605-2990
Practice Address - Fax:909-622-6810
Is Sole Proprietor?:No
Enumeration Date:2018-06-06
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY31369103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist