Provider Demographics
NPI:1194264853
Name:SANCHEZ, MARY GUADALUPE (MS)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:GUADALUPE
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 RALSTON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6042
Mailing Address - Country:US
Mailing Address - Phone:805-910-7317
Mailing Address - Fax:
Practice Address - Street 1:5450 RALSTON ST STE 109
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6042
Practice Address - Country:US
Practice Address - Phone:805-910-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-14
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115485106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist