=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265689590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUIS ARTURO SANDOVAL MARTINEZ M.D
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2008
-----------------------------------------------------
Last Update Date | 06/12/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1919 NORTH LOOP W STE 140
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-688-1800
-----------------------------------------------------
Fax | 832-408-7875
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1200 POST OAK BLVD APT 2407
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77056-3199
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-688-1800
-----------------------------------------------------
Fax | 832-408-7875
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | N1126
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------