1316354830 NPI number — DONALD S STAAB JR, FNP & JOSE R SANCHEZ, MD

Table of content: (NPI 1316354830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316354830 NPI number — DONALD S STAAB JR, FNP & JOSE R SANCHEZ, MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DONALD S STAAB JR, FNP & JOSE R SANCHEZ, MD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1316354830
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3625 MISSION AVE STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMICHAEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95608-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-486-1906
Provider Business Mailing Address Fax Number:
916-486-1206

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3625 MISSION AVE STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMICHAEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95608-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
916-486-1906
Provider Business Practice Location Address Fax Number:
916-486-1206
Provider Enumeration Date:
07/16/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SLECHTA
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
916-601-4513

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G61393 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP0020190 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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