Individual provider Active NPI

Guillermo Sandoval, MD

  • Pediatrics Physician
  • Madera, CA
National Provider Identifier
1063552966
Registry record updated Sep 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G62609 Issued in CA
Practice address
344 E 6TH St
Madera, CA 93638-3631
Phone
(559) 664-4000
Fax
(559) 675-5661
NPI assigned
Feb 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G62609 CA Primary

Addresses

Primary practice location

344 E 6TH St
Madera, CA 93638-3631

Mailing address

344 E 6TH St
Madera, CA 93638-3631
Phone (559) 664-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040816001498 CA Practitioner - Pediatric MedicinePractitioner - Emergency Medicine 7214900422 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G62609CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Camarena Health Pediatrics Current Accepting new patients
Camarena Health CurrentSince Nov 3, 2021 Accepting new patients
Camarena Health CurrentSince Nov 3, 2021 Accepting new patients
Emergency Medicine Physician Partners of Madera County, Inc Past Accepting new patients
Fresno Community Hospital and Medical Center Past Accepting new patients
Valley Children'S Hospital Past Accepting new patients

Locations

124 S A St
Madera, CA 93638
Phone (559) 664-4042

344 E 6th St
Madera, CA 93638
Phone (559) 664-4158

441 E Yosemite Ave
Madera, CA 93638

49169 Road 426
Oakhurst, CA 93644
Phone (559) 642-6724

Interoperability endpoints

  • Direct secure messaging: guillermo.sandoval.1@25900.direct.athenahealth.com

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1378684800000",
    "number": "1063552966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "344 E 6TH ST",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936383631",
            "telephone_number": "559-664-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "344 E 6TH ST",
            "city": "MADERA",
            "state": "CA",
            "postal_code": "936383631",
            "telephone_number": "559-664-4000",
            "fax_number": "559-675-5661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "GUILLERMO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-08",
        "last_updated": "2013-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G62609",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madera, CA

Sources for this page

Verify at the official NPI Registry.