Basic Information
| Provider Information | |||||||||
| NPI: | 1407019151 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | OMAR | ||||||||
| MiddleName: | ESTEBAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 731 N ST ANDREWS PL APT 409 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900384135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2134472440 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3875 S WESTERN AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900621105 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232904352 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2008 | ||||||||
| LastUpdateDate: | 07/02/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | 234183 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
No ID Information.