Provider Demographics
NPI:1285467233
Name:SANDOVAL, ADRIANA D (MD PHL)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:D
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD PHL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1298
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-1298
Mailing Address - Country:US
Mailing Address - Phone:787-224-4118
Mailing Address - Fax:
Practice Address - Street 1:359 CALLE SAN CLAUDIO
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926-9907
Practice Address - Country:US
Practice Address - Phone:787-224-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-24
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4503235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist