Provider Demographics
NPI:1861006835
Name:WOOD-RODRIGUEZ, IMANI ANDREA (STUDENT)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:ANDREA
Last Name:WOOD-RODRIGUEZ
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 W 60TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7905
Mailing Address - Country:US
Mailing Address - Phone:212-333-3444
Mailing Address - Fax:212-333-5444
Practice Address - Street 1:33 W 60TH ST FL 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7905
Practice Address - Country:US
Practice Address - Phone:212-333-3444
Practice Address - Fax:212-333-5444
Is Sole Proprietor?:No
Enumeration Date:2020-09-07
Last Update Date:2020-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program