Provider Demographics
NPI:1366313306
Name:SANCHEZ, KEITH
Entity type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 N BARRANCA AVE # 9225
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1722
Mailing Address - Country:US
Mailing Address - Phone:530-619-5053
Mailing Address - Fax:
Practice Address - Street 1:440 N BARRANCA AVE # 9225
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1722
Practice Address - Country:US
Practice Address - Phone:530-619-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA958292083S0010X, 225700000X, 2081N0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular MedicineGroup - Multi-Specialty
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist