Provider Demographics
NPI:1922131747
Name:SANDOVAL, RONALD O (LAC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:O
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 222
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3640
Mailing Address - Country:US
Mailing Address - Phone:631-424-8601
Mailing Address - Fax:631-424-8603
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:SUITE 222
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:631-424-8601
Practice Address - Fax:631-424-8603
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001938-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist