Healthcare Provider Details

I. General information

NPI: 1003872094
Provider Name (Legal Business Name): DAVID MARCELINO SANDOVAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2006
Last Update Date: 06/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6710 W OKANOGAN PLACE
KENNEWICK WA
99336
US

IV. Provider business mailing address

560 GAGE BLVD SUITE 203
RICHLAND WA
99352
US

V. Phone/Fax

Practice location:
  • Phone: 509-783-2000
  • Fax: 509-783-2008
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD00032746
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: