Provider Demographics
NPI:1073629242
Name:ALVELO RODRIGUEZ, MARIA DEL C (DMDD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:DEL C
Last Name:ALVELO RODRIGUEZ
Suffix:
Gender:F
Credentials:DMDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7402
Mailing Address - Street 2:
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00732-7402
Mailing Address - Country:US
Mailing Address - Phone:787-842-4959
Mailing Address - Fax:
Practice Address - Street 1:2525 AVE EDUARDO RUBERTE
Practice Address - Street 2:SUITE 107 COLISEO SHOPPING CENTER
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1739
Practice Address - Country:US
Practice Address - Phone:787-842-4959
Practice Address - Fax:787-842-4959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice