Healthcare Provider Details

I. General information

NPI: 1609785831
Provider Name (Legal Business Name): SANDRA RODRIGUEZ PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5210 LEIGH AVE
SAN JOSE CA
95124-5616
US

IV. Provider business mailing address

175 W SAINT JAMES ST UNIT 308
SAN JOSE CA
95110-2407
US

V. Phone/Fax

Practice location:
  • Phone: 408-626-3405
  • Fax:
Mailing address:
  • Phone: 408-915-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220107809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: