Provider Demographics
NPI:1871113225
Name:SANCHEZ SANTANA, ANNET DE LAS MERCEDES II
Entity type:Individual
Prefix:MRS
First Name:ANNET
Middle Name:DE LAS MERCEDES
Last Name:SANCHEZ SANTANA
Suffix:II
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 1:3090 LIBERTY CIR N
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89121-1330
Mailing Address - Country:US
Mailing Address - Phone:702-738-8136
Mailing Address - Fax:
Practice Address - Street 1:3090 LIBERTY CIR N
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-1330
Practice Address - Country:US
Practice Address - Phone:702-738-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-25
Last Update Date:2020-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2105614761106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV7027388136Medicaid
NVSSNMedicaid