Provider Demographics
NPI:1780625822
Name:SANDOVAL, CARLOS (MD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:SANDOVAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 NW NORTH RIVER DR
Mailing Address - Street 2:# 110
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-2900
Mailing Address - Country:US
Mailing Address - Phone:305-926-7782
Mailing Address - Fax:
Practice Address - Street 1:99198 OVERSEAS HWY STE 5
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2437
Practice Address - Country:US
Practice Address - Phone:305-434-7660
Practice Address - Fax:305-451-8019
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME678212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378161500Medicaid
FLG11254Medicare UPIN
FL27659Medicare PIN