Basic Information
| Provider Information | |||||||||
| NPI: | 1982355442 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | ISRAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 80958 GLEN HAVEN DR | ||||||||
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| City: | INDIO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922012879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7604856475 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2990 LOMITA BLVD # B | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905055102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3105463461 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2022 | ||||||||
| LastUpdateDate: | 01/15/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 301526 | CA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.