1255339362 NPI number — DR. BROC ENRIQUE RAMON DEPENA SANCHEZ APRN (NP)

Table of content: DR. BROC ENRIQUE RAMON DEPENA SANCHEZ APRN (NP) (NPI 1255339362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255339362 NPI number — DR. BROC ENRIQUE RAMON DEPENA SANCHEZ APRN (NP)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
BROC
Provider Middle Name:
ENRIQUE RAMON DEPENA
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
APRN (NP)
Provider Gender Code:
M

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:
1255339362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9331 E LAKE HIGHLANDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218-2723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-859-9934
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9331 E LAKE HIGHLANDS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75218-2723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-328-8378
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2005

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: 363LF0000X , with the licence number:  AP108991 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 090010-23 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP108991 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 090010-23 . This is a "CLINIC NURSE SPECIALIST-ADULT PSYCHIATRIC MENTAL HEALTH" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: FNP009228 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02687 . This is a "STATE PRESCRIPTIVE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 090010-23 . This is a "FAMILY PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 69929 . This is a "CERTIFIED NURSE PRACTITIONER-FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NUR-APRN-LIC-204079 . This is a "CLINICAL NURSE SPECIALIST-ADULT PSYCHIATRIC MENTAL HEALTH" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: APRN-3756 . This is a "FAMILY PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 0327382 . This is a "FAMILY NURSE PRACTITIONER -BOARD CERTIFICATION-ANCC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 090010-23 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: AP108991 . This is a "ADVANCED PRACTICE REGISTERED NURSE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AP61367800 . This is a "ADVANCED RN PRACTITIONER-FAMILY PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: NUR-APRN-LIC-204079 . This is a "CERTIFIED NURSE PRACTITIONER-FAMILY PSYCHIATRIC-MENTAL HEALTH NURSE PRACTITIONER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 249794 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 60129595 . This is a "PREVIOUS-DEPARTMENT OF PUBLIC SAFETY -CONTROLLED SUBSTANCE REGISTRATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AP61367800 . This is a "CERTIFIED NURSE PRACTITIONER-FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: APRN-3756 . This is a "FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: NUR-APRN-LIC-204079 . This is a "CERTIFIED NURSE PRACTITIONER-FAMILY NURSE PRACTITIONER" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 108122 . This is a "REGISTERED NURSE" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".
  • Identifier: 69929 . This is a "CERTIFIED NURSE PRACTITIONER-FAMILY PSYCHIATRIC MENTAL HEALTH NURSE PRACTITIONER" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: APRN-3756 . This is a "ADULT PSYCHIATRIC & MENTAL HEALTH CLINICAL NURSE SPECIALISTS" identifier , issued by the state of ( HI ) . This identifiers is of the category "OTHER".




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