Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0100X | Health Service |
NPI | 1265186993 |
---|---|
Provider Name | Sergio Alejandro Sanchez Carrasco |
First Address | Tangent, OR 97389-9735 |
Second Address | Albany, OR 97321-2272 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2022 |
Last Update Date | 10/02/2022 |