Healthcare Provider Details

I. General information

NPI: 1497135883
Provider Name (Legal Business Name): SANDRA RODRIGUEZ FERNANDEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2015
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 W ALEXANDER ST
PLANT CITY FL
33563-7116
US

IV. Provider business mailing address

1324 LAKELAND HILLS BLVD MANAGED CARE DEPT
LAKELAND FL
33805
US

V. Phone/Fax

Practice location:
  • Phone: 863-284-5000
  • Fax: 863-284-1916
Mailing address:
  • Phone: 863-687-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME134868
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: