Provider Demographics
NPI:1366516254
Name:RODRIGUEZ, SANDRA VERA (FNP, CDE)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:VERA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4118 POND HILL RD BLDG 3
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1281
Mailing Address - Country:US
Mailing Address - Phone:210-494-3739
Mailing Address - Fax:
Practice Address - Street 1:4118 POND HILL RD BLDG 3
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1281
Practice Address - Country:US
Practice Address - Phone:210-494-3739
Practice Address - Fax:210-494-4508
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX626712363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ77752Medicare UPIN
TX8J3494Medicare PIN