Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 212 | CA |
NPI | 1023279494 |
---|---|
Provider Name | Elizabeth M. Rodriguez |
First Address | Santee, CA 92072 |
Second Address | Santee, CA 92071 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2008 |
Last Update Date | 26/03/2013 |