Provider Demographics
NPI:1992737076
Name:SANDOVAL-CORTEZ, DIANA I (MD)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:I
Last Name:SANDOVAL-CORTEZ
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:823 GATEWAY CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92102-4541
Mailing Address - Country:US
Mailing Address - Phone:619-515-2323
Mailing Address - Fax:619-906-4564
Practice Address - Street 1:8788 JAMACHA RD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-4035
Practice Address - Country:US
Practice Address - Phone:619-515-2555
Practice Address - Fax:619-462-5584
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2021-12-02
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Provider Licenses
StateLicense IDTaxonomies
CAA66726207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH24467Medicare UPIN