Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 47413 | CA |
NPI | 1245252618 |
---|---|
Provider Name | Maria Elena Rodriguez |
First Address | Torrance, CA 90505-4763 |
Second Address | Torrance, CA 90505-4763 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |