Provider Demographics
NPI:1053934729
Name:SANDOVAL, ANTONIO (PA-C)
Entity type:Individual
Prefix:
First Name:ANTONIO
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 S PASEO DOROTEA STE 2
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-1437
Mailing Address - Country:US
Mailing Address - Phone:760-320-6988
Mailing Address - Fax:760-320-9796
Practice Address - Street 1:552 S PASEO DOROTEA STE 2
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-1437
Practice Address - Country:US
Practice Address - Phone:760-320-6988
Practice Address - Fax:760-320-9796
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2024-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant