Provider Demographics
NPI:1790048817
Name:DR. GUSTAVO SANDIGO
Entity Type:Organization
Organization Name:DR. GUSTAVO SANDIGO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GUSTAVO
Authorized Official - Middle Name:H
Authorized Official - Last Name:SANDIGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-572-9654
Mailing Address - Street 1:111 NORTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2924
Mailing Address - Country:US
Mailing Address - Phone:361-572-9654
Mailing Address - Fax:
Practice Address - Street 1:111 NORTHPARK DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2924
Practice Address - Country:US
Practice Address - Phone:361-572-9654
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2777207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
90082672OtherDPS
TX129610504Medicaid
BS2947591OtherDEA
F35995Medicare UPIN
90082672OtherDPS