1225245442 NPI number — LUISA ENGRACIA SANCHEZ OTR

Table of content: LUISA ENGRACIA SANCHEZ OTR (NPI 1225245442)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225245442 NPI number — LUISA ENGRACIA SANCHEZ OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANCHEZ
Provider First Name:
LUISA
Provider Middle Name:
ENGRACIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
OTR
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:
1225245442
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 WASHINGTON AVE
Provider Second Line Business Mailing Address:
LIBERTY ESTATES
Provider Business Mailing Address City Name:
SAN BENITO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78586
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-440-1155
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2117 E TYLER AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-7211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-440-0580
Provider Business Practice Location Address Fax Number:
956-440-0584
Provider Enumeration Date:
05/17/2007

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: 225X00000X , with the licence number:  111784 , 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: 8T6437 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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