Healthcare Provider Details

I. General information

NPI: 1295313757
Provider Name (Legal Business Name): DR. ANTONELLA RODRIGUEZ SANTANA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW STE M3400
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

3800 RESERVOIR RD NW STE M3400
WASHINGTON DC
20007-2113
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-8161
  • Fax:
Mailing address:
  • Phone: 202-444-8161
  • Fax: 202-444-4924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116037168
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: