Provider Demographics
NPI:1265115810
Name:GIL SANCHEZ, GUSTAVO MIGUEL
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:MIGUEL
Last Name:GIL SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3035 PINEHILLS WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NC
Mailing Address - Zip Code:28120
Mailing Address - Country:US
Mailing Address - Phone:631-835-4242
Mailing Address - Fax:
Practice Address - Street 1:3035 PINEHILLS WAY
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NC
Practice Address - Zip Code:28120
Practice Address - Country:US
Practice Address - Phone:631-835-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCG346CP347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle