Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DN25169 | FL |
NPI | 1003434572 |
---|---|
Provider Name | Mrs. Carla Rodriguez |
First Address | Hialeah, FL 33018-1244 |
Second Address | Hialeah, FL 33018-1244 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2020 |
Last Update Date | 10/07/2020 |