Provider Demographics
NPI:1811717242
Name:SANCHEZ, GABRIEL J
Entity type:Individual
Prefix:
First Name:GABRIEL
Middle Name:J
Last Name: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 1:44425 MONTICELLO AVE
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4036
Mailing Address - Country:US
Mailing Address - Phone:760-408-3543
Mailing Address - Fax:
Practice Address - Street 1:44425 MONTICELLO AVE
Practice Address - Street 2:
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4036
Practice Address - Country:US
Practice Address - Phone:760-408-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program