Provider Demographics
NPI:1598077547
Name:MARY J. SANDOVAL, DPM,P.A.
Entity Type:Organization
Organization Name:MARY J. SANDOVAL, DPM,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDOVAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:713-932-0111
Mailing Address - Street 1:1220 BLALOCK RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-6472
Mailing Address - Country:US
Mailing Address - Phone:713-932-0111
Mailing Address - Fax:713-932-0184
Practice Address - Street 1:1220 BLALOCK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6472
Practice Address - Country:US
Practice Address - Phone:713-932-0111
Practice Address - Fax:713-932-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-07
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1046213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT15732Medicare PIN