Provider Demographics
NPI:1790148708
Name:SARMIENTO, JOEL
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:SARMIENTO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4919 E BEVERLY MAE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4937
Mailing Address - Country:US
Mailing Address - Phone:936-675-4440
Mailing Address - Fax:
Practice Address - Street 1:13917 W HIGHWAY 71 STE A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78738-3008
Practice Address - Country:US
Practice Address - Phone:512-610-7030
Practice Address - Fax:512-610-7034
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-29
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS0376208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program