Provider Demographics
NPI:1205461324
Name:SANCHEZ, RAFAEL E (LPN)
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:E
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 94TH ST APT 2M
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5026
Mailing Address - Country:US
Mailing Address - Phone:347-622-6311
Mailing Address - Fax:
Practice Address - Street 1:5610 94TH ST APT 2M
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5026
Practice Address - Country:US
Practice Address - Phone:347-622-6311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY337999164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse