Provider Demographics
NPI:1528062346
Name:SANDOVAL, ANTHONY B (MD)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:B
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:505-662-7122
Practice Address - Street 1:4967 TRINITY DR
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-3009
Practice Address - Country:US
Practice Address - Phone:505-699-0202
Practice Address - Fax:505-662-4712
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2025-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NM84-112207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM39461Medicaid
NM39461Medicaid