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General NPI Number Information
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NPI Number | 1356838916
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Entity Type | Individual
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Provider Name | GONZALO SANDOVAL RT(R)
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Gender | Male
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Dates
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Enumeration Date | 04/19/2018
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Last Update Date | 04/19/2018
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Provider Practice Location Address
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Address Line | 7400 MERTON MINTER ST
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4404
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Country | US
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Telephone | 210-617-5300
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Fax |
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Provider Business Mailing Address
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Address Line | 9113 LONGHORN PARK
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City | CONVERSE
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State | TX
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Zip | 78109-2816
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Country | US
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Telephone | 928-366-0191
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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 | 2085B0100X
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Taxonomy Name | Body Imaging Physician
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License Number | GMR02002128
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License Number State | TX
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