Provider Demographics
NPI:1326389156
Name:RODRIGUEZ, SARA
Entity Type:Individual
Prefix:
First Name:SARA
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 1:1015 THROGGS NECK EXPY
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2124
Mailing Address - Country:US
Mailing Address - Phone:917-501-4501
Mailing Address - Fax:
Practice Address - Street 1:1015 THROGGS NECK EXPY
Practice Address - Street 2:3RD FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-2124
Practice Address - Country:US
Practice Address - Phone:917-501-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-04
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator