Individual
PHILLIP SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4901 LANG AVE NE, ALBUQUERQUE, NM 87109-4495
(505) 842-8171
(505) 246-0684
Mailing address
800 BRADBURY DR SE STE 116, ALBUQUERQUE, NM 87106-4310
(505) 272-1476
(505) 246-0684
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
97359
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55379
—
NM
Enumeration date
11/21/2006
Last updated
01/22/2026
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