Provider Demographics
NPI:1346137676
Name:SANCHEZ BERNAL, KEVIN ANTONIO
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:ANTONIO
Last Name:SANCHEZ BERNAL
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 1:22039 W MOHAVE ST
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-8651
Mailing Address - Country:US
Mailing Address - Phone:323-428-8721
Mailing Address - Fax:
Practice Address - Street 1:6700 E SPEEDWAY BLVD STE 401
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-1220
Practice Address - Country:US
Practice Address - Phone:520-448-9005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBACB724251106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician