Provider Demographics
NPI:1891932521
Name:RODRIGUEZ, ROXANA E (RDA)
Entity Type:Individual
Prefix:MISS
First Name:ROXANA
Middle Name:E
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6203 PICO VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-3359
Mailing Address - Country:US
Mailing Address - Phone:562-977-3494
Mailing Address - Fax:
Practice Address - Street 1:6203 PICO VISTA RD
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-3359
Practice Address - Country:US
Practice Address - Phone:562-977-3494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53043126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant