Provider Demographics
NPI:1114935350
Name:SANDOVAL, MARIA J (DPM)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:J
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23230 RED RIVER DR
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77494-2046
Mailing Address - Country:US
Mailing Address - Phone:281-395-3338
Mailing Address - Fax:281-395-3338
Practice Address - Street 1:1331 W GRAND PKWY N STE 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2711
Practice Address - Country:US
Practice Address - Phone:281-395-3338
Practice Address - Fax:281-395-3496
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018615701Medicaid
TX00A34LMedicare PIN
TX018615701Medicaid