1730885542 NPI number — MR. VINCENT SANDOVAL

Table of content: MR. VINCENT SANDOVAL (NPI 1730885542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730885542 NPI number — MR. VINCENT SANDOVAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDOVAL
Provider First Name:
VINCENT
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730885542
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2821 W HORIZON RIDGE PKWY STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-4429
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-893-3333
Provider Business Mailing Address Fax Number:
702-893-0960

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7250 PEAK DR STE 118
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89128-9028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-846-2100
Provider Business Practice Location Address Fax Number:
702-665-5170
Provider Enumeration Date:
02/02/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 227800000X , with the licence number:  RC3352 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RC3352 . This is a "PRACTITIONER OF RESPIRATORY CARE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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