Provider Demographics
NPI:1386295632
Name:SANCHEZ, MIMI S (FNP)
Entity type:Individual
Prefix:
First Name:MIMI
Middle Name:S
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MIMI
Other - Middle Name:
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15710 SPINNING AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-4645
Mailing Address - Country:US
Mailing Address - Phone:310-447-4930
Mailing Address - Fax:
Practice Address - Street 1:15710 SPINNING AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-4645
Practice Address - Country:US
Practice Address - Phone:310-447-4930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95007097363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily