Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 1839 | PR |
NPI | 1003953134 |
---|---|
Provider Name | Dr. Rosa M Rodriguez |
First Address | Caguas, PR 00725-3740 |
Second Address | San Juan, PR 00918-3721 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |