Provider Demographics
NPI:1770731697
Name:SANDIEGO, RODERICK JOSEPH (RN)
Entity type:Individual
Prefix:
First Name:RODERICK
Middle Name:JOSEPH
Last Name:SANDIEGO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N HILDEBRAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08029-1276
Mailing Address - Country:US
Mailing Address - Phone:856-939-1940
Mailing Address - Fax:
Practice Address - Street 1:517 N HILDEBRAND AVE
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:NJ
Practice Address - Zip Code:08029-1276
Practice Address - Country:US
Practice Address - Phone:856-939-1940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN570082163W00000X
NJ26NR11701300163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse