Provider Demographics
NPI:1801486501
Name:SANCHEZ, ITTAY BERNARDO I
Entity type:Individual
Prefix:
First Name:ITTAY
Middle Name:BERNARDO
Last Name:SANCHEZ
Suffix:I
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 1:19622 133RD AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:GRAHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98338-8114
Mailing Address - Country:US
Mailing Address - Phone:253-468-2280
Mailing Address - Fax:
Practice Address - Street 1:19622 133RD AVENUE CT E
Practice Address - Street 2:
Practice Address - City:GRAHAM
Practice Address - State:WA
Practice Address - Zip Code:98338-8114
Practice Address - Country:US
Practice Address - Phone:253-468-2880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-26
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPMC15657171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA47-2682728OtherLABOR AND INDUSTRIES