Provider Demographics
NPI:1477533354
Name:RODONI, SIGRID L (RPT)
Entity Type:Individual
Prefix:MRS
First Name:SIGRID
Middle Name:L
Last Name:RODONI
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:MISS
Other - First Name:SIGRID
Other - Middle Name:L
Other - Last Name:MOELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPT
Mailing Address - Street 1:453 ISBEL DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-1923
Mailing Address - Country:US
Mailing Address - Phone:831-234-9354
Mailing Address - Fax:831-600-7837
Practice Address - Street 1:453 ISBEL DR
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-1923
Practice Address - Country:US
Practice Address - Phone:831-234-9354
Practice Address - Fax:831-600-7837
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19929ZMedicare ID - Type Unspecified