Provider Demographics
NPI:1790941268
Name:SANDOVAL, JAVIER E (DO)
Entity Type:Individual
Prefix:
First Name:JAVIER
Middle Name:E
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3151 N ALAFAYA TRL
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2945
Mailing Address - Country:US
Mailing Address - Phone:407-207-5000
Mailing Address - Fax:407-207-8920
Practice Address - Street 1:3151 N ALAFAYA TRL
Practice Address - Street 2:SUITE 101
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2945
Practice Address - Country:US
Practice Address - Phone:407-207-5000
Practice Address - Fax:407-207-8920
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS9933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000346400Medicaid
FL76578OtherBCBS
FLCK768ZMedicare UPIN