Provider Demographics
NPI:1326797424
Name:RODRIGUEZ, ANNA VICTORIA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:VICTORIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST STE 450
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2115
Mailing Address - Country:US
Mailing Address - Phone:952-920-9191
Mailing Address - Fax:
Practice Address - Street 1:1515 SAINT FRANCIS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-3387
Practice Address - Country:US
Practice Address - Phone:952-445-6700
Practice Address - Fax:952-445-3527
Is Sole Proprietor?:No
Enumeration Date:2022-03-23
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN79327208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics