Provider Demographics
NPI:1477542736
Name:SANDOVAL RODRIGUEZ, ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:SANDOVAL RODRIGUEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8940
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-8940
Mailing Address - Country:US
Mailing Address - Phone:787-535-1001
Mailing Address - Fax:787-738-1390
Practice Address - Street 1:CARR 14
Practice Address - Street 2:
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736-4105
Practice Address - Country:US
Practice Address - Phone:787-535-1001
Practice Address - Fax:787-738-1390
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR10882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR8-3184Medicare ID - Type Unspecified
G27592Medicare UPIN