Provider Demographics
NPI:1437312519
Name:RODRIGUEZ DAVILA, SANDRA L (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:L
Last Name:RODRIGUEZ DAVILA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10948 N 56TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3007
Mailing Address - Country:US
Mailing Address - Phone:813-284-6993
Mailing Address - Fax:813-374-9603
Practice Address - Street 1:10948 N 56TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-3007
Practice Address - Country:US
Practice Address - Phone:813-284-6993
Practice Address - Fax:813-374-9603
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-08
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1033262084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010895800Medicaid
FL010895800Medicaid