Provider Demographics
NPI:1750364030
Name:SANDOVAL, SALVADOR JR (MD)
Entity type:Individual
Prefix:DR
First Name:SALVADOR
Middle Name:
Last Name:SANDOVAL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1763 GROGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6455
Mailing Address - Country:US
Mailing Address - Phone:209-725-7149
Mailing Address - Fax:209-726-0134
Practice Address - Street 1:535 W 25TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2838
Practice Address - Country:US
Practice Address - Phone:209-722-9066
Practice Address - Fax:209-383-1522
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG32098207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G320980OtherBLUE SHIELD OF CA PIN
CA028184OtherBOARD CERT #
CA028184OtherBOARD CERT #
CAAS7421706OtherDEA CERT
CAA45005Medicare UPIN