Provider Demographics
NPI:1356807135
Name:SANCHEZ, HECTOR LUIS SR
Entity type:Individual
Prefix:
First Name:HECTOR
Middle Name:LUIS
Last Name:SANCHEZ
Suffix:SR
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 1:333 LAURINA ST APT 130
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-9054
Mailing Address - Country:US
Mailing Address - Phone:786-720-3271
Mailing Address - Fax:
Practice Address - Street 1:333 LAURINA ST APT 130
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-9054
Practice Address - Country:US
Practice Address - Phone:786-720-3271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2019-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLS522332893820172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLNAMedicaid