Provider Demographics
NPI:1427229418
Name:RODRIGUEZ, GLORIA MONICA (DHAP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:MONICA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:746 S ALVARADO ST
Mailing Address - Street 2:STE #8 DE LA CRUZ DENTAL AP INC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057
Mailing Address - Country:US
Mailing Address - Phone:213-989-6859
Mailing Address - Fax:213-989-6933
Practice Address - Street 1:746 S ALVARADO ST
Practice Address - Street 2:STE #8 DE LA CRUZ DENTAL AP INC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057
Practice Address - Country:US
Practice Address - Phone:213-989-6859
Practice Address - Fax:213-989-6933
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist