Provider Demographics
NPI:1811252026
Name:SANDOVAL GONZALEZ, JUAN ADRIAN (MD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ADRIAN
Last Name:SANDOVAL GONZALEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUAN
Other - Middle Name:ADRIAN
Other - Last Name:SANDOVAL-GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1501 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724
Mailing Address - Country:US
Mailing Address - Phone:520-626-6114
Mailing Address - Fax:
Practice Address - Street 1:1501 N CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85724-5030
Practice Address - Country:US
Practice Address - Phone:520-626-6114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-13
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53065207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine