Provider Demographics
NPI:1316354830
Name:DONALD S STAAB JR, FNP & JOSE R SANCHEZ, MD
Entity type:Organization
Organization Name:DONALD S STAAB JR, FNP & JOSE R SANCHEZ, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:SLECHTA
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:916-601-4513
Mailing Address - Street 1:3625 MISSION AVE STE D
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-2954
Mailing Address - Country:US
Mailing Address - Phone:916-486-1906
Mailing Address - Fax:916-486-1206
Practice Address - Street 1:3625 MISSION AVE STE D
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-2954
Practice Address - Country:US
Practice Address - Phone:916-486-1906
Practice Address - Fax:916-486-1206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG61393207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANP0020190Medicaid
CAZZZ17928ZMedicare PIN