Provider Demographics
NPI:1659758761
Name:SANDBERG, PATTYANN
Entity Type:Individual
Prefix:
First Name:PATTYANN
Middle Name:
Last Name:SANDBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:64 GOLF HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:LAGUNA VISTA
Mailing Address - State:TX
Mailing Address - Zip Code:78578
Mailing Address - Country:US
Mailing Address - Phone:956-551-0798
Mailing Address - Fax:
Practice Address - Street 1:64 GOLF HOUSE RD
Practice Address - Street 2:
Practice Address - City:LAGUNA VISTA
Practice Address - State:TX
Practice Address - Zip Code:78578
Practice Address - Country:US
Practice Address - Phone:956-551-0798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10092650172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker