Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 124Q00000X | Dental Hygienist | 5757 | AZ |
NPI | 1033322961 |
---|---|
Provider Name | Isabel Rodriquez |
First Address | Phoenix, AZ 85019 |
Second Address | Phoenix, AZ 85015 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2007 |
Last Update Date | 08/07/2007 |