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General NPI Number Information
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NPI Number | 1316501778
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Entity Type | Individual
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Provider Name | CHAVA SANDOVAL PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 5050 NE HOYT ST STE 610
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City | PORTLAND
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State | OR
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Zip | 97213-2985
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Country | US
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Telephone | 503-467-4761
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 622
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City | HALFWAY
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State | OR
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Zip | 97834-0622
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 194638
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License Number State | OR
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