Provider Demographics
NPI:1407010598
Name:SANDOVAL LINARES, OTTO ROBERTO (MD)
Entity Type:Individual
Prefix:
First Name:OTTO
Middle Name:ROBERTO
Last Name:SANDOVAL LINARES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:OTTO
Other - Middle Name:R
Other - Last Name:SANDOVAL LINARES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:442 CIVIC CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-8572
Mailing Address - Country:US
Mailing Address - Phone:207-622-6319
Mailing Address - Fax:
Practice Address - Street 1:442 CIVIC CENTER DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-8572
Practice Address - Country:US
Practice Address - Phone:207-622-6319
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD25699208800000X
NY274614208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology