Healthcare Provider Details

I. General information

NPI: 1053934729
Provider Name (Legal Business Name): ANTONIO SANDOVAL PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2020
Last Update Date: 02/17/2024
Certification Date: 02/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

552 S PASEO DOROTEA STE 2
PALM SPRINGS CA
92264-1437
US

IV. Provider business mailing address

552 S PASEO DOROTEA STE 2
PALM SPRINGS CA
92264-1437
US

V. Phone/Fax

Practice location:
  • Phone: 760-320-6988
  • Fax: 760-320-9796
Mailing address:
  • Phone: 760-320-6988
  • Fax: 760-320-9796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: