Provider Demographics
NPI:1265186993
Name:SANCHEZ CARRASCO, SERGIO ALEJANDRO
Entity type:Individual
Prefix:
First Name:SERGIO
Middle Name:ALEJANDRO
Last Name:SANCHEZ CARRASCO
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 1:32020 GRIFFITH DR
Mailing Address - Street 2:
Mailing Address - City:TANGENT
Mailing Address - State:OR
Mailing Address - Zip Code:97389-9735
Mailing Address - Country:US
Mailing Address - Phone:480-246-4681
Mailing Address - Fax:
Practice Address - Street 1:445 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2272
Practice Address - Country:US
Practice Address - Phone:541-967-3866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-10
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service