Healthcare Provider Details

I. General information

NPI: 1134073349
Provider Name (Legal Business Name): SABASTIAN RODRIGUEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 JEFFERSON ST NE
ALBUQUERQUE NM
87110-3901
US

IV. Provider business mailing address

5001 SAN MATEO LN NE APT 43
ALBUQUERQUE NM
87109-2437
US

V. Phone/Fax

Practice location:
  • Phone: 631-662-5410
  • Fax:
Mailing address:
  • Phone: 631-662-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172P00000X
TaxonomyNaprapath
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: