Provider Demographics
NPI:1871826966
Name:SANCHEZ, JASON EZEQUIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:EZEQUIEL
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1290 E SPRUCE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3371
Mailing Address - Country:US
Mailing Address - Phone:559-431-2397
Mailing Address - Fax:559-435-2132
Practice Address - Street 1:1290 E SPRUCE AVE STE 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3371
Practice Address - Country:US
Practice Address - Phone:559-431-2397
Practice Address - Fax:559-435-2132
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20499363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical