Provider Demographics
NPI:1821402983
Name:RODRIGUEZ, SOFIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SOFIA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24862 HON AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4316
Mailing Address - Country:US
Mailing Address - Phone:949-294-0736
Mailing Address - Fax:
Practice Address - Street 1:362 3RD ST
Practice Address - Street 2:SUITE 2
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2307
Practice Address - Country:US
Practice Address - Phone:949-494-2125
Practice Address - Fax:949-494-2111
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2018-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No122300000XDental ProvidersDentist