Epifanio Gloria Sandoval, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

01030388A Issued in IN

Practice address

3903 Indianapolis Blvd
East Chicago, IN 46312-2555

Phone

(219) 398-7050

Fax

(219) 392-6998

NPI assigned

Aug 16, 2005

Last updated

May 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305590400000",
    "number": "1659363828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8400 LOUISIANA ST",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464106385",
            "telephone_number": "219-757-1928",
            "fax_number": "219-757-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3903 INDIANAPOLIS BLVD",
            "city": "EAST CHICAGO",
            "state": "IN",
            "postal_code": "463122555",
            "telephone_number": "219-398-7050",
            "fax_number": "219-392-6998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "EPIFANIO",
        "middle_name": "GLORIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-16",
        "last_updated": "2011-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01030388A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS",
            "identifier": "000000213350",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100325110",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ahmed Sabry, M.D
• Saint Margaret Mercy Dialysis Centers, LLC (East Chicago Dialysis Center)
• Selena Samardzich, FNP
• Sams Place 78 LLC
• Berenis Sandoval
• Maria Sangueza, RPH
• Claudia Guadalupe Santacruz, PA-C
• Rachel Santay, MD
• Yarikza Santiago
• School City of East Chicago

• Psychiatry Physician in East Chicago, IN
• Providers in East Chicago, IN by specialty
• Psychiatry Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.