Provider Demographics
NPI:1265297683
Name:RODRIGUEZ ROJAS, LAURA PATRICIA
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:PATRICIA
Last Name:RODRIGUEZ ROJAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 GENERAL BOOTH BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-5934
Mailing Address - Country:US
Mailing Address - Phone:757-821-7397
Mailing Address - Fax:
Practice Address - Street 1:2204 GENERAL BOOTH BLVD STE 400
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-5934
Practice Address - Country:US
Practice Address - Phone:757-821-7397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-15
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA04014191931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program