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General NPI Number Information
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NPI Number | 1205224508
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Entity Type | Individual
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Provider Name | RAUL SANDOVAL JR. CRNA
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Gender | Male
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Dates
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Enumeration Date | 01/08/2015
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Last Update Date | 02/04/2020
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Provider Practice Location Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 915-504-0540
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Fax |
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Provider Business Mailing Address
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Address Line | 1500 S MAIN ST
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City | FORT WORTH
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State | TX
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Zip | 76104-4917
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Country | US
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Telephone | 915-504-0540
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | AP127178
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License Number State | TX
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