Healthcare Provider Details

I. General information

NPI: 1881944874
Provider Name (Legal Business Name): MRS. SANDRA RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2012
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 3RD AVE
NEW YORK NY
10029-2184
US

IV. Provider business mailing address

2089 3RD AVE
NEW YORK NY
10029-2184
US

V. Phone/Fax

Practice location:
  • Phone: 212-828-6144
  • Fax: 212-828-6145
Mailing address:
  • Phone: 212-828-6144
  • Fax: 212-828-6145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: