Healthcare Provider Details

I. General information

NPI: 1881538668
Provider Name (Legal Business Name): SANDRA LYNN RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4567 HAMILTON AVE APT 3
SAN JOSE CA
95130-1464
US

IV. Provider business mailing address

4567 HAMILTON AVE APT 3
SAN JOSE CA
95130-1464
US

V. Phone/Fax

Practice location:
  • Phone: 408-780-4744
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: