Provider Demographics
NPI:1922782291
Name:SANCHEZ, JACK MICHAEL (RBT-23-278104)
Entity Type:Individual
Prefix:
First Name:JACK
Middle Name:MICHAEL
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:RBT-23-278104
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3411 WILCOX RD # K136
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-9553
Mailing Address - Country:US
Mailing Address - Phone:707-972-9263
Mailing Address - Fax:
Practice Address - Street 1:3411 WILCOX RD # K136
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-9553
Practice Address - Country:US
Practice Address - Phone:707-972-9263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRBT-23-278104247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other