Provider Demographics
NPI:1003378167
Name:RODRIGUEZ, SANDY
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6130 W TROPICANA AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89103-4604
Mailing Address - Country:US
Mailing Address - Phone:702-900-7698
Mailing Address - Fax:702-825-0791
Practice Address - Street 1:2820 W CHARLESTON BLVD STE 22
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89102
Practice Address - Country:US
Practice Address - Phone:702-900-7698
Practice Address - Fax:702-825-0791
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician