Provider Demographics
NPI:1316162258
Name:SANCHEZ, DAVID A (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1674
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92702-1674
Mailing Address - Country:US
Mailing Address - Phone:714-480-6800
Mailing Address - Fax:714-480-9285
Practice Address - Street 1:1614 FRENCH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92701-2419
Practice Address - Country:US
Practice Address - Phone:714-480-6800
Practice Address - Fax:714-480-9285
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2017-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55647208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A556470Medicaid
CAW22016Medicare PIN
CAG49077Medicare UPIN