Basic Information
| Provider Information | |||||||||
| NPI: | 1366516254 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RODRIGUEZ | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | VERA | ||||||||
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| Credential: | FNP, CDE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4118 POND HILL RD BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | SHAVANO PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4118 POND HILL RD BLDG 3 | ||||||||
| Address2: | |||||||||
| City: | SHAVANO PARK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782311281 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104943739 | ||||||||
| FaxNumber: | 2104944508 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 626712 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.