MEDICARE: DR. RICARDO MIGUEL SANDOVAL MD

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
1	2084P0800X	Psychiatry Physician	ME0055135	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11359	OTHER	FL	PROVIDER IDENTIFICATON NU
2	ME 55135	OTHER	FL	MEDICAL LICENSE NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851474357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICARDO MIGUEL SANDOVAL MD

Provider Business Mailing Address
First Line	:	595 NE 92ND ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-3162
Country	:	US
Telephone Number	:	305-756-1283
Fax Number	:	305-756-9839

Provider Business Practice Location Address
First Line	:	595 NE 92ND ST
Second Line	:
City	:	MIAMI SHORES
State	:	FL
Zip	:	33138-3162
Country	:	US
Telephone Number	:	305-756-1283
Fax Number	:	305-756-9839

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	03/07/2023

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