Provider Demographics
NPI:1992450050
Name:SANCHEZ, JARISSA YVETTE I
Entity type:Individual
Prefix:
First Name:JARISSA
Middle Name:YVETTE
Last Name:SANCHEZ
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24742 HEMLOCK AVE APT 102
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-7378
Mailing Address - Country:US
Mailing Address - Phone:951-722-0526
Mailing Address - Fax:
Practice Address - Street 1:24742 HEMLOCK AVE APT 102
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-7378
Practice Address - Country:US
Practice Address - Phone:951-722-0526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician