Provider Demographics
NPI:1215976964
Name:SANDOVAL, NELSON A (MD)
Entity type:Individual
Prefix:DR
First Name:NELSON
Middle Name:A
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5055 E BROADWAY BLVD
Mailing Address - Street 2:STE A-100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3640
Mailing Address - Country:US
Mailing Address - Phone:520-327-0460
Mailing Address - Fax:520-795-0225
Practice Address - Street 1:6540 E CARONDELET DR
Practice Address - Street 2:NELSON A SANDOVAL MD
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710
Practice Address - Country:US
Practice Address - Phone:520-751-8114
Practice Address - Fax:520-751-8062
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2021-09-08
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Provider Licenses
StateLicense IDTaxonomies
AZ22531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ168957Medicaid