MEDICARE: SANDRA OVIEDO PA

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
1	363A00000X	Physician Assistant	PA2479	NV

General Provider Information

NPI Number	:	1053084905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA OVIEDO PA

Provider Business Mailing Address
First Line	:	PO BOX 33340
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3340
Country	:	US
Telephone Number	:	702-405-7100
Fax Number	:	702-405-3017

Provider Business Practice Location Address
First Line	:	2480 PROFESSIONAL CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0835
Country	:	US
Telephone Number	:	702-405-7100
Fax Number	:	702-405-3017

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2021
Last Update Date	:	07/27/2021

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Directions to “ SANDRA OVIEDO PA” Practice Location

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