Provider Demographics
NPI:1053092601
Name:SANCHEZ, SAMANTHA
Entity type:Individual
Prefix:MRS
First Name:SAMANTHA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:776 S STATE ST STE 103
Mailing Address - Street 2:
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5833
Mailing Address - Country:US
Mailing Address - Phone:707-463-4915
Mailing Address - Fax:707-463-4917
Practice Address - Street 1:7690 EAST ROAD
Practice Address - Street 2:
Practice Address - City:REDWOOD VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95470
Practice Address - Country:US
Practice Address - Phone:707-467-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2024-07-09
Deactivation Date:2024-05-23
Deactivation Code:
Reactivation Date:2024-06-04
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker