Provider Demographics
NPI:1497889083
Name:RODRIGUES-LONERGAN, SOPHIA E (BS, MA, RNCNP)
Entity Type:Individual
Prefix:MS
First Name:SOPHIA
Middle Name:E
Last Name:RODRIGUES-LONERGAN
Suffix:
Gender:F
Credentials:BS, MA, RNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2016 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85713-3509
Mailing Address - Country:US
Mailing Address - Phone:520-882-4252
Mailing Address - Fax:520-792-2835
Practice Address - Street 1:7490 S CAMINO DE OESTE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9308
Practice Address - Country:US
Practice Address - Phone:520-879-6000
Practice Address - Fax:520-879-6135
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12566363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASS1964881Medicare ID - Type UnspecifiedCHDP