Provider Demographics
NPI:1770207094
Name:SANDATE-SANCHEZ, JESUS
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:
Last Name:SANDATE-SANCHEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 BURKE RD APT 211
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1836
Mailing Address - Country:US
Mailing Address - Phone:956-502-8962
Mailing Address - Fax:
Practice Address - Street 1:3219 BURKE RD APT 211
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1836
Practice Address - Country:US
Practice Address - Phone:956-502-8962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372500000XNursing Service Related ProvidersChore Provider
No253Z00000XAgenciesIn Home Supportive Care
No372600000XNursing Service Related ProvidersAdult Companion
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
77504211OtherHOMECARE+ ADMIN