Provider Demographics
NPI:1326659780
Name:SANDOVAL LOPEZ, GABRIELA ARELY (PA)
Entity Type:Individual
Prefix:
First Name:GABRIELA
Middle Name:ARELY
Last Name:SANDOVAL LOPEZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GABY
Other - Middle Name:
Other - Last Name:SANDOVAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:120 BRENTWOOD COMMONS WAY STE 510
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-2028
Mailing Address - Country:US
Mailing Address - Phone:615-377-5602
Mailing Address - Fax:
Practice Address - Street 1:915 E MARKET AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72149-5615
Practice Address - Country:US
Practice Address - Phone:501-279-5642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant