Basic Information
| Provider Information | |||||||||
| NPI: | 1043343460 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | ELISAMUEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 ATLANTIC AVE. | ||||||||
| Address2: | #17A | ||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022102253 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178874670 | ||||||||
| FaxNumber: | 6178874646 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 EVERETT AVE | ||||||||
| Address2: | SUITE 16C | ||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021502309 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178874670 | ||||||||
| FaxNumber: | 6178874646 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WD0400X | 194213 | MA | Y | Nursing Service Providers | Registered Nurse | Diabetes Educator |
No ID Information.