Provider Demographics
NPI:1437544293
Name:SANDOVAL, BRENDA GISSELA (MD)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:GISSELA
Last Name:SANDOVAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 DOTSON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-4305
Mailing Address - Country:US
Mailing Address - Phone:908-247-2920
Mailing Address - Fax:
Practice Address - Street 1:13333 DOTSON RD STE 220
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-4305
Practice Address - Country:US
Practice Address - Phone:908-247-2920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-30
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCT1836207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty