Healthcare Provider Details

I. General information

NPI: 1598077547
Provider Name (Legal Business Name): MARY J. SANDOVAL, DPM,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 BLALOCK RD SUITE 250
HOUSTON TX
77055-6472
US

IV. Provider business mailing address

1220 BLALOCK RD SUITE 250
HOUSTON TX
77055-6472
US

V. Phone/Fax

Practice location:
  • Phone: 713-932-0111
  • Fax: 713-932-0184
Mailing address:
  • Phone: 713-932-0111
  • Fax: 713-932-0184

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number1046
License Number StateTX

VIII. Authorized Official

Name: DR. MARY SANDOVAL
Title or Position: OWNER
Credential: DPM
Phone: 713-932-0111