Provider Demographics
NPI:1679584668
Name:SANDOVAL, CRUZ VICTOR (RMT)
Entity Type:Individual
Prefix:MR
First Name:CRUZ
Middle Name:VICTOR
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:RMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78852-4718
Mailing Address - Country:US
Mailing Address - Phone:830-757-2610
Mailing Address - Fax:830-757-2610
Practice Address - Street 1:2125 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-4718
Practice Address - Country:US
Practice Address - Phone:830-757-2610
Practice Address - Fax:830-757-2610
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT028265225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist