Healthcare Provider Details

I. General information

NPI: 1669448809
Provider Name (Legal Business Name): SANDRA S RODRIGUEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 12/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

253 CALLE SAN JORGE 2A SUITE
SAN JUAN PR
00912-3307
US

IV. Provider business mailing address

PO BOX 16323
SAN JUAN PR
00908-6323
US

V. Phone/Fax

Practice location:
  • Phone: 787-728-3441
  • Fax: 787-287-2610
Mailing address:
  • Phone: 787-728-3441
  • Fax: 787-287-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9534
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: