Provider Demographics
NPI:1386344208
Name:SANCHEZ, JOSE III (INTERN)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:SANCHEZ
Suffix:III
Gender:M
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 N TEILMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93705-1050
Mailing Address - Country:US
Mailing Address - Phone:559-803-1697
Mailing Address - Fax:
Practice Address - Street 1:1101 E UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93741-0001
Practice Address - Country:US
Practice Address - Phone:559-442-8268
Practice Address - Fax:559-499-6050
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA390200000OtherSTUDENT IN AN ORGANIZED HEALTH CARE EDUCATION/TRAINING PROGRAM