Healthcare Provider Details

I. General information

NPI: 1982957171
Provider Name (Legal Business Name): SANDRA C RODRIGUEZ NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SANDRA C RAMIREZ FNP-C

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 09/23/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 BREN RD E
MINNETONKA MN
55343-9664
US

IV. Provider business mailing address

12487 TIERRA ENCINO DR
EL PASO TX
79938-4524
US

V. Phone/Fax

Practice location:
  • Phone: 915-208-0243
  • Fax:
Mailing address:
  • Phone: 915-929-9409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number649668
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP122574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: