Provider Demographics
NPI:1932549763
Name:SANCHEZ, MICHAEL R (JD, BCBA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:JD, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10742 CARIUTO CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2023
Mailing Address - Country:US
Mailing Address - Phone:619-993-7816
Mailing Address - Fax:
Practice Address - Street 1:27720 JEFFERSON AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-2610
Practice Address - Country:US
Practice Address - Phone:951-699-8640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA 1-12-10369103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst