Provider Demographics
NPI:1205828076
Name:RODRIGUEZ, SANDRA FLORINE (CNM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:FLORINE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4140
Mailing Address - Country:US
Mailing Address - Phone:805-548-0033
Mailing Address - Fax:805-548-0034
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4140
Practice Address - Country:US
Practice Address - Phone:805-548-0033
Practice Address - Fax:805-548-0034
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA430367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARN226769Medicaid