Provider Demographics
NPI:1558687541
Name:RODRIGUEZ, SANDRA HERNANDEZ (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:HERNANDEZ
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:SANDRA
Other - Middle Name:HERNANDEZ
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:5502 N. SAN BERNARDO
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041
Mailing Address - Country:US
Mailing Address - Phone:956-728-9979
Mailing Address - Fax:
Practice Address - Street 1:5502 SAN BERNARDO AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-3008
Practice Address - Country:US
Practice Address - Phone:956-728-9979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX669287363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner