Provider Demographics
NPI:1871202713
Name:SANDERS, JORGE ABEL JR (AS)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:ABEL
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:AS
Other - Prefix:MR
Other - First Name:GEORGE
Other - Middle Name:A
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5850 GRANITE PKWY STE 600
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-6753
Mailing Address - Country:US
Mailing Address - Phone:818-345-2345
Mailing Address - Fax:
Practice Address - Street 1:27990 SHERMAN RD
Practice Address - Street 2:
Practice Address - City:MENIFEE
Practice Address - State:CA
Practice Address - Zip Code:92585-9155
Practice Address - Country:US
Practice Address - Phone:951-309-9135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician