Provider Demographics
NPI:1912521006
Name:SANCHEZ, MICHELLE GRACE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GRACE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-937-8555
Mailing Address - Fax:310-937-8556
Practice Address - Street 1:514 N PROSPECT AVE STE 103
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-3037
Practice Address - Country:US
Practice Address - Phone:310-937-8555
Practice Address - Fax:310-937-8556
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95013986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily