Provider Demographics
NPI:1366505422
Name:RODRIGUEZ, SONIA NICOLASA (BS)
Entity Type:Individual
Prefix:MISS
First Name:SONIA
Middle Name:NICOLASA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 STARDALE RD
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-7064
Mailing Address - Country:US
Mailing Address - Phone:919-924-6053
Mailing Address - Fax:919-462-3548
Practice Address - Street 1:112 STARDALE RD
Practice Address - Street 2:
Practice Address - City:MORRISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27560-7064
Practice Address - Country:US
Practice Address - Phone:919-924-6053
Practice Address - Fax:919-882-8926
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301513Medicaid