Provider Demographics
NPI:1043771439
Name:SANDOVAL, TINA LOUISE (LVN)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:LOUISE
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 N LOOP 1604 E STE 350
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1289
Mailing Address - Country:US
Mailing Address - Phone:210-803-7706
Mailing Address - Fax:
Practice Address - Street 1:400 N LOOP 1604 E STE 350
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1289
Practice Address - Country:US
Practice Address - Phone:210-255-1466
Practice Address - Fax:210-255-1488
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193462364SH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SH0200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistHome Health