Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204C00000X | Sports Medicine Doctor | A38661 | CA |
Y | 207R00000X | Internist | A38661 | CA |
Y | 111NI0900X | Internist | A38661 | CA |
NPI | 1588737068 |
---|---|
Provider Name | Dr. Lucio Sanchez |
First Address | Huntington Park, CA 90255 |
Second Address | Huntington Park, CA 90255 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 15/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E99044 | (02) | CA |