Provider Demographics
NPI:1538778923
Name:SANCHEZ, CYNTHIA (NDTR)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:SANCHEZ
Suffix:
Gender:F
Credentials:NDTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4925 W SANDRA TER
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-2035
Mailing Address - Country:US
Mailing Address - Phone:623-340-8994
Mailing Address - Fax:
Practice Address - Street 1:4925 W SANDRA TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-2035
Practice Address - Country:US
Practice Address - Phone:623-340-8994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ136A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes136A00000XDietary & Nutritional Service ProvidersDietetic Technician, Registered