MEDICARE: ANDREA CORUJO-RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207L00000X	Anesthesiology Physician	9206	GA

General Provider Information

NPI Number	:	1730422577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CORUJO-RODRIGUEZ

Provider Business Mailing Address
First Line	:	3331 LANTERN VIEW LN
Second Line	:
City	:	SCOTTDALE
State	:	GA
Zip	:	30079-6807
Country	:	US
Telephone Number	:	787-585-9456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1364 CLIFTON RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30322-1501
Country	:	US
Telephone Number	:	404-712-2000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	03/29/2018

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Directions to “ ANDREA CORUJO-RODRIGUEZ ” Practice Location

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