Provider Demographics
NPI:1215385398
Name:KARINA RODRIGUEZ
Entity Type:Organization
Organization Name:KARINA RODRIGUEZ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-632-5872
Mailing Address - Street 1:PO BOX 431902
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92143-1902
Mailing Address - Country:US
Mailing Address - Phone:619-632-5872
Mailing Address - Fax:
Practice Address - Street 1:CALLE SEPTIMA #8033, ZONA CENTRO
Practice Address - Street 2:
Practice Address - City:TIJUANA
Practice Address - State:B.C.
Practice Address - Zip Code:22000
Practice Address - Country:MX
Practice Address - Phone:619-632-5872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-30
Last Update Date:2016-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ52769771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty