Individual
JOB L SANDOVAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
350 LIBERTY ST, PAWCATUCK, CT 06379-1354
(860) 599-9961
Mailing address
350 LIBERTY ST, PAWCATUCK, CT 06379-1354
(860) 599-9961
(860) 972-7040
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
29158
CT
207R00000X
Internal Medicine Physician
7098
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004674595
AETNA
—
01
—
010007098RL01
CONNECTICUT BLUE CROSS
—
01
—
0400364
UNITED HEALTH
—
01
—
050431424 02891 A001
TRICARE
—
01
—
0R0283
HEALTH NET
—
01
—
110020788
RAILROAD MEDICARE
RI
05
—
1790815157
—
CT
01
—
3066520
CONNECTICUT MEDICAL ASSIS
—
01
—
4095
RI BLUE CHIP
—
01
—
41605
BLUE SHIELD
RI
01
—
41605
FEDERAL BLUE SHIELD
—
01
—
731424
CONNECTICARE
—
05
—
9000416
—
RI
01
—
9258294
CIGNA
—
01
—
D400654480
MEDICARE
CT
01
—
D400737416
MEDICARE
CT
01
—
P02475705
RAILROAD MEDICARE
CT
01
—
P405784
OXFORD
—
Enumeration date
03/06/2007
Last updated
08/23/2021
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