Healthcare Provider Details

I. General information

NPI: 1174571624
Provider Name (Legal Business Name): GUSTAVO H SANDIGO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 JAMES COLEMAN DR SUITE A
VICTORIA TX
77904-3109
US

IV. Provider business mailing address

202 JAMES COLEMAN DR STE A
VICTORIA TX
77904-3111
US

V. Phone/Fax

Practice location:
  • Phone: 361-573-4000
  • Fax: 361-485-0684
Mailing address:
  • Phone: 361-573-4000
  • Fax: 361-485-0684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License NumberJ2777
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberJ2777
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: