Provider Demographics
NPI:1407883168
Name:RODRIGUEZ, LORNA AIMEE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORNA
Middle Name:AIMEE
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:PO BOX 2440
Mailing Address - Street 2:
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00970
Mailing Address - Country:US
Mailing Address - Phone:787-792-1391
Mailing Address - Fax:787-792-1391
Practice Address - Street 1:1453 AVE SAN IGNACIO
Practice Address - Street 2:ALTAMESA
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-4718
Practice Address - Country:US
Practice Address - Phone:787-792-1391
Practice Address - Fax:797-792-1391
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice