Basic Information
| Provider Information | |||||||||
| NPI: | 1306181458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | MARISA | ||||||||
| MiddleName: | ANGELICA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 265 SAN JACINTO RIVER RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516749243 | ||||||||
| FaxNumber: | 9516749635 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 SAN JACINTO RIVER RD STE 107 | ||||||||
| Address2: | |||||||||
| City: | LAKE ELSINORE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925304400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9516749243 | ||||||||
| FaxNumber: | 9516749635 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2012 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | Behavioral Health & Social Service Providers | Behavioral Analyst | 106H00000X | 121159 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.