Individual provider Active NPI

Sandra Florine Rodriguez, C.N.M.

  • Advanced Practice Midwife
  • San Luis Obispo, CA
National Provider Identifier
1205828076
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Advanced Practice MidwifeTaxonomy code 367A00000X
License
430 Issued in CA
Practice address
1941 Johnson Ave
Suite 202
San Luis Obispo, CA 93401-4140
Phone
(805) 548-0033
Fax
(805) 548-0034
NPI assigned
Aug 18, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Advanced Practice Midwife 367A00000X 430 CA Primary

Addresses

Primary practice location

1941 Johnson Ave
Suite 202
San Luis Obispo, CA 93401-4140

Mailing address

1941 Johnson Ave
Suite 202
San Luis Obispo, CA 93401-4140
Phone (805) 548-0033

Other identifiers 1

IdentifierTypeStateIssuer
RN226769MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services: No
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Midwife

State licenses

LicenseStateTypeSpecialty
430CAMDMidwife

Practice roles

OrganizationSpecialtyStatusNew patients
Doctors Medical Center of Modesto, Inc. Past Accepting new patients
Creating Harmony Women's Healthcare Inc Advanced Practice Midwife PastSince Nov 28, 2015 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1205828076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE",
            "address_2": "SUITE 202",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014140",
            "telephone_number": "805-548-0033",
            "fax_number": "805-548-0034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1941 JOHNSON AVE",
            "address_2": "SUITE 202",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014140",
            "telephone_number": "805-548-0033",
            "fax_number": "805-548-0034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "SANDRA",
        "middle_name": "FLORINE",
        "credential": "C.N.M.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-18",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "430",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "RN226769",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Luis Obispo, CA

Sources for this page

Verify at the official NPI Registry.