Provider Demographics
NPI:1942846118
Name:SANCHEZ, SELINA
Entity Type:Individual
Prefix:
First Name:SELINA
Middle Name:
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 1:9999 FOOTHILL BLVD SPC 69
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3655
Mailing Address - Country:US
Mailing Address - Phone:909-332-8815
Mailing Address - Fax:
Practice Address - Street 1:9999 FOOTHILL BLVD SPC 69
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3655
Practice Address - Country:US
Practice Address - Phone:909-332-8815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-22
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty