Basic Information
| Provider Information | |||||||||
| NPI: | 1861628620 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDOVAL | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | RENAE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2509 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856235095 | ||||||||
| FaxNumber: | 7856235080 | ||||||||
| Practice Location | |||||||||
| Address1: | 2509 CANTERBURY DR | ||||||||
| Address2: | |||||||||
| City: | HAYS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 676012233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856235095 | ||||||||
| FaxNumber: | 7856235080 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 07/20/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2007017367 | MO | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.