Provider Demographics
NPI:1609835024
Name:SANDOVAL, JULIO ROBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ROBERTO
Last Name:SANDOVAL
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 1:1817 W WATROUS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3042
Mailing Address - Country:US
Mailing Address - Phone:813-251-3971
Mailing Address - Fax:
Practice Address - Street 1:1817 W WATROUS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3042
Practice Address - Country:US
Practice Address - Phone:813-251-3971
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME414522085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00229398OtherRR MEDICARE
FLP00244244OtherRR MEDICARE
FL065677100Medicaid
FL07528Medicare PIN
FLP00244244OtherRR MEDICARE
B99043Medicare UPIN
FL07528DMedicare PIN
FL07528WMedicare PIN