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NPI Code Detail

MEDICARE: DR. LUIS MANUEL SANDOVAL MD

MEDICARE: DR. LUIS MANUEL SANDOVAL MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianA98748CA
22084P0800XPsychiatry PhysicianA98748CA

General Provider Information

NPI Number : 1033244660
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LUIS MANUEL SANDOVAL MD
Provider Business Mailing Address
First Line : 519 S PACIFIC AVE
Second Line :
City : SANTA ANA
State : CA
Zip : 92703-4420
Country : US
Telephone Number : 714-206-3789
Fax Number :
Provider Business Practice Location Address
First Line : 1900 E 4TH ST
Second Line : 2ND FLOOR
City : SANTA ANA
State : CA
Zip : 92705-3910
Country : US
Telephone Number : 714-223-4589
Fax Number : 714-967-4575
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/23/2007
Last Update Date : 10/16/2021

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