Provider Demographics
NPI:1487978862
Name:SANDOVAL, MARINA PENTEADO (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:MARINA
Middle Name:PENTEADO
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 NW 92ND WAY
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6035
Mailing Address - Country:US
Mailing Address - Phone:310-809-7432
Mailing Address - Fax:954-633-3753
Practice Address - Street 1:895 SW 30TH AVE STE 101
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-4887
Practice Address - Country:US
Practice Address - Phone:310-809-7432
Practice Address - Fax:954-633-3465
Is Sole Proprietor?:No
Enumeration Date:2010-03-15
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME116387207ZD0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZD0900XAllopathic & Osteopathic PhysiciansPathologyDermatopathology