Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | MD00032746 | WA |
NPI | 1003872094 |
---|---|
Provider Name | David Marcelino Sandoval |
First Address | Richland, WA 99352 |
Second Address | Kennewick, WA 99336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/04/2006 |
Last Update Date | 17/06/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0284410 | L&I (01) | WA |
1003872094 | (05) | WA |
F75447 | (02) | OR |