Provider Demographics
NPI:1760795132
Name:SANDOVAL, OSCAR (PA)
Entity Type:Individual
Prefix:
First Name:OSCAR
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1901 S 1ST ST STE 600
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1228
Mailing Address - Country:US
Mailing Address - Phone:956-631-6136
Mailing Address - Fax:956-631-1848
Practice Address - Street 1:801 E NOLANA AVE STE 13A
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-6112
Practice Address - Country:US
Practice Address - Phone:956-686-2700
Practice Address - Fax:956-686-2708
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXPA06909363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX317048207Medicaid
TXTXB114890Medicare PIN