Female

Itzel Sandoval-reynoso PA-C

Medical Physician Assistant in Jacksonville, FL(View on Map)

Full Name

Itzel Sandoval-reynoso PA-C

NPI Number

1356011514

NPI Type

Individual Provider

Gender

Female

Enumeration Date

09/17/2021

Specialties

(Taxonomies)

Code

363AM0700X
363A00000X

Primary Taxonomy

Yes
No

Licenses

State

Florida

License Number

PA9115077

Contact
Information

Purpose

Mailing
Location

Address

6520 FORT CAROLINE RD
1215 DUNN AVE STE 1

City

Jacksonville
Jacksonville

State

FL
FL

Postal Code

32277-2044
32218-4897

Country

US
US

Telephone Number

(904) 745-3618
(904) 696-7474

Identifiers

Identifier

112060700
OF335

Identifier State

FL
FL

Identifier Issuer

Unknown
MEDICARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 04/04/2022

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