Provider Demographics
NPI:1043615792
Name:SANCHEZ, KRISTINA ANITA
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANITA
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2209 WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-5837
Mailing Address - Country:US
Mailing Address - Phone:805-739-1512
Mailing Address - Fax:805-739-2855
Practice Address - Street 1:1125 E CLARK AVE STE A2
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-5192
Practice Address - Country:US
Practice Address - Phone:805-739-1512
Practice Address - Fax:805-739-2855
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator