Provider Demographics
NPI:1497520068
Name:RODRIGUEZ, SANDRA (RPT, CMAS, RMA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RPT, CMAS, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 ARCH ST STE 408
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-2446
Mailing Address - Country:US
Mailing Address - Phone:445-206-2025
Mailing Address - Fax:
Practice Address - Street 1:917 ARCH ST
Practice Address - Street 2:STE 408
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2446
Practice Address - Country:US
Practice Address - Phone:445-206-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-23
Last Update Date:2023-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA250144246RP1900X, 246R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Multi-Specialty
No246R00000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Pathology