Provider Demographics
NPI:1003953134
Name:RODRIGUEZ, ROSA M (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 AVE RAFAEL CORDERO
Mailing Address - Street 2:PMB 471, SUITE140
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-3740
Mailing Address - Country:US
Mailing Address - Phone:787-753-2376
Mailing Address - Fax:787-767-8392
Practice Address - Street 1:377 AVE DOMENECH
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-3721
Practice Address - Country:US
Practice Address - Phone:787-753-2376
Practice Address - Fax:787-767-8392
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR18391223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry