Provider Demographics
NPI:1356428916
Name:SANCHEZ, JOSE R (MD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:R
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 MANZANITA AVE
Mailing Address - Street 2:STE B-3
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-0891
Mailing Address - Country:US
Mailing Address - Phone:916-481-3042
Mailing Address - Fax:916-481-3044
Practice Address - Street 1:4800 MANZANITA AVE
Practice Address - Street 2:STE B-3
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-0891
Practice Address - Country:US
Practice Address - Phone:916-481-3042
Practice Address - Fax:916-481-3044
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61393174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE24812Medicare UPIN