Healthcare Provider Details

I. General information

NPI: 1528062346
Provider Name (Legal Business Name): ANTHONY B SANDOVAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4967 TRINITY DR
LOS ALAMOS NM
87544-3009
US

IV. Provider business mailing address

800 BRADBURY DR SE STE 116
ALBUQUERQUE NM
87106-4310
US

V. Phone/Fax

Practice location:
  • Phone: 505-699-0202
  • Fax: 505-662-4712
Mailing address:
  • Phone: 505-272-1476
  • Fax: 505-662-7122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number84-112
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: