NPI Code Detail JSON Logo

1821356114 NPI number — LUAR SANDOVAL PA-C

NPI Number: 1821356114
Health Care Provider/Practitioner: LUAR SANDOVAL PA-C

Information about “1821356114” NPI (LUAR SANDOVAL PA-C) exists in 1821356114 in HTML format HTML  |  1821356114 in plain Text format TXT  |  1821356114 in PDF (Portable Document Format) PDF  |  1821356114 in an XML format XML  formats.

NPI Number : 1821356114 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1821356114",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SANDOVAL",
    "FirstName": "LUAR",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "700 N PEARL ST STE N510",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75201-2863",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "214-580-7277",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "201 COMMERCE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT WORTH",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76102-7206",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "682-610-7900",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/25/2012",
    "LastUpdateDate": "08/14/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QM1102X",
          "TaxonomyName": "Military Outpatient Operational (Transportable) Component Clinic/Center",
          "LicenseNumber": "PA9116542",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA9116542",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA17558",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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