Provider Demographics
NPI:1598871766
Name:SANDOVAL, RAYNALDO GLORIA (MD)
Entity Type:Individual
Prefix:DR
First Name:RAYNALDO
Middle Name:GLORIA
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1860 ROSEMERE COURT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-2061
Mailing Address - Country:US
Mailing Address - Phone:702-233-0950
Mailing Address - Fax:702-838-4873
Practice Address - Street 1:630 SOUTH RANCHO DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106
Practice Address - Country:US
Practice Address - Phone:702-636-4047
Practice Address - Fax:702-636-4008
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI17102207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease