Provider Demographics
NPI:1194434811
Name:SANCHEZ NERI, ROBERTO IVAN (NP)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:IVAN
Last Name:SANCHEZ NERI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 N INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90032-3616
Mailing Address - Country:US
Mailing Address - Phone:323-633-5944
Mailing Address - Fax:
Practice Address - Street 1:6021 PACIFIC BLVD STE 103
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-2953
Practice Address - Country:US
Practice Address - Phone:323-300-6211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95023383363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner