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NPI Code Detail

MEDICARE: MR. RICHARD ANTHONY SANDOVAL PA

MEDICARE: MR. RICHARD ANTHONY SANDOVAL PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant51313CA

General Provider Information

NPI Number : 1245660729
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD ANTHONY SANDOVAL PA
Provider Business Mailing Address
First Line : 38618 15TH ST E
Second Line :
City : PALMDALE
State : CA
Zip : 93550-3904
Country : US
Telephone Number : 661-435-8307
Fax Number :
Provider Business Practice Location Address
First Line : 4900 CALIFORNIA AVE STE 400B
Second Line :
City : BAKERSFIELD
State : CA
Zip : 93309-7081
Country : US
Telephone Number : 661-459-1900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/19/2013
Last Update Date : 11/19/2013

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