Provider Demographics
NPI:1861156325
Name:SANDOVAL, OMAR E (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:OMAR
Middle Name:E
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 WEST LOOP S STE 200F
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-3535
Mailing Address - Country:US
Mailing Address - Phone:713-572-8122
Mailing Address - Fax:713-383-1462
Practice Address - Street 1:6500 WEST LOOP S STE 200-B
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-3503
Practice Address - Country:US
Practice Address - Phone:713-486-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-29
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057676363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily