Provider Demographics
NPI:1609067321
Name:DR. GUILLERMO RODRIGUEZ DENTAL CORP
Entity Type:Organization
Organization Name:DR. GUILLERMO RODRIGUEZ DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GUILLERMO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:619-282-7094
Mailing Address - Street 1:3200 ADAMS AVE
Mailing Address - Street 2:202
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1643
Mailing Address - Country:US
Mailing Address - Phone:619-282-7094
Mailing Address - Fax:619-282-2514
Practice Address - Street 1:3200 ADAMS AVE
Practice Address - Street 2:202
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1643
Practice Address - Country:US
Practice Address - Phone:619-282-7094
Practice Address - Fax:619-282-2514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-07
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA522940Medicare PIN