Provider Demographics
NPI:1750477691
Name:RODRIGUEZ, JACQUELINE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
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 5715
Mailing Address - Street 2:
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00726-5715
Mailing Address - Country:US
Mailing Address - Phone:787-732-0509
Mailing Address - Fax:787-924-7324
Practice Address - Street 1:STREET 156 KM 48.8 BO SUMIDERO
Practice Address - Street 2:
Practice Address - City:AGUAS BUENAS
Practice Address - State:PR
Practice Address - Zip Code:00703-9819
Practice Address - Country:US
Practice Address - Phone:787-732-0509
Practice Address - Fax:787-924-7324
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24111223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice