Healthcare Provider Details

I. General information

NPI: 1538554308
Provider Name (Legal Business Name): LUISA SANDOVAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2015
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3145 PORTER DR RM B119
PALO ALTO CA
94304-1234
US

IV. Provider business mailing address

3145 PORTER DR RM B119
PALO ALTO CA
94304-1234
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-8995
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number29739
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number183253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: