1013919844 NPI number — MS. GUADALUPE SANCHEZ MD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013919844 NPI number — MS. GUADALUPE SANCHEZ MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
GUADALUPE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013919844
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
12/16/2014
NPI Reactivation Date:
08/20/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
70 JUNGERMANN CIR
Provider Second Line Business Mailing Address:
#203, FAMILY DERMATOLOGY CENTER LC
Provider Business Mailing Address City Name:
ST PETERS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63376-1622
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-447-5197
Provider Business Mailing Address Fax Number:
636-928-0994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 JUNGERMANN CIR
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
ST PETERS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63376-1622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-447-5197
Provider Business Practice Location Address Fax Number:
636-928-0994
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  R7D23 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 070001270 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 180467 . This is a "HEALTHLINK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7588 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 202216016 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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