Provider Demographics
NPI:1942099791
Name:RODRIGUEZ, ANDREA SOPHIA
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:SOPHIA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB.PORTAL DE SANTA MARIA 30 MALVA 6
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00927
Mailing Address - Country:US
Mailing Address - Phone:787-690-0955
Mailing Address - Fax:
Practice Address - Street 1:URB.PORTAL DE SANTA MARIA 30 MALVA 6
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00927
Practice Address - Country:US
Practice Address - Phone:787-690-0955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR7170998390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program